Housing Advocacy 101 for CARE Court Counsel

ABI: Hello, everyone, thank you for joining us. I am Abi Resendiz‑Zuniga here at the Office of State Public Defender. I am so glad to welcome y’all to the Housing Advocacy 101 for CARE Court Counsel presented with the Disability Rights Education and Defense Fund. I am happy to welcome Claudia Center, the legal director with DREDF. Peter Talkington, the Judy Heumann Fellow with DREDF. And Kim Swain, a retired attorney and former managing attorney and Disability Rights California ‑‑ with Disability Rights California.

DREDF’s mission is to advance the civil and human rights of people living with disabilities through legal advocacy, training, and public policy and legislative development. Their work is focused on promoting a quality of opportunity, disability accommodations, accessibility, and full inclusion for folks living with disabilities.

As we move through today’s presentation, please feel free to submit any questions in the Q&A. Thank you so much for being here. And I am going to be handing it over to our presenters. The floor is yours, Claudia. Thank you.

CLAUDIA CENTER: Thank you, Abi. This is Claudia with DREDF, and I wanted to tell you what our training topics are today, and they’re pretty big, so this is really going to be an overview of these big training topics.

So, one thing we’re going to do is try to describe to you California’s mental health system, which operates through the counties in virtually every instance.

And so the two biggest components of the California mental health system is Medi‑Cal, which you probably know of, it’s Medicaid and it’s sort of federal and state funding together administered by the State of California and the counties.

And then we have something very specific to California called the Behavioral Health Services Act, used to be called the Mental Health Services Act. And there are some new pieces of the Behavioral Health Services Act that we’re going to talk about, which is there are revised spending allocations that were part of a proposition that were passed that has changed our housing options, or at least the funding for those options. And there’s something called an integrated plan that’s now required that we’re going to tell you a little bit about. They’re brand new, so we’re all going to learn about them  together. So, once we review sort of the overview of the California mental health system, we’re going to talk about the supports that are available in California related to housing that CARE Court respondents are most likely eligible for. One that’s brand new is something called a housing plan with four housing supports. Sometimes the housing supports are called community supports, which is confusing. But it’s the same thing. And this is a Medi‑Cal service and support. A second support related to housing is something called full service partnership, which has been around for a while. So you may have already heard this term, full service partnership. And we’ll tell you what that is. Another thing that is brand new is something called housing interventions. And these are housing supports that are funded by the state money, not by the Medi‑Cal system. And it is supposed to come into play when all the Medi‑Cal supports are exhausted. And then finally, we have behavioral health bridge housing, which some of you have probably heard of; that’s been around for a while as well. And these are all supports for which CARE Court respondents should be at the front of the line or pretty near to the front of the line.

KIM SWAIN: Claudia did a good job of describing the basics of Medi‑Cal versus the Behavioral Health Services Act, but I think what’s happened over the last few years has been both of these systems have really realigned to better serve people with significant behavioral health issues. And also to refocus their priorities, including the services and the dollars to help individuals who are unhoused, secure, and pay for and keep housing in California. So, there really has better realignment and reprioritization to both people with severe mental health needs and housing homeless individuals in the state. And it couldn’t be made clearer than looking at Prop 1, based in 2024, which is the Behavioral Health Services Act, formerly the Mental Health Services Act, but this really shifted the funding that comes in through that program, provided a one‑time $6.4 billion bond, 2 billion of it to go to general supporting needs, other kinds of housing subsidies; 4.4 billion to go to treatment beds, including involuntary hospital beds ‑‑ So, the big dollars in this Behavioral Health Services Act come from the continuation of a 1% tax on millionaires, it’s the Millionaire Tax, of which you can see how much money is generated to support the behavioral health system. In fiscal year ’25‑’26, it was $3.5 billion alone. The changes that the Behavioral Health Services Act made were to really insist that certain dollars go specifically to fund services for homeless people and individuals with the most significant mental health needs.

So 30% of the BHSA dollars go to housing interventions; 50% of those to chronically homeless; 35% go to full service partnerships, which are wrap‑around services for people with significant mental health needs. And Claudia is going to talk more about how you get those services and what they are. And then the final 35% is behavioral health services and supports, which can include things like suicide prevention and outreach, et cetera. But as you can see, there’s really a 65% of services are going to go to house clients who would oftentimes be served by public defenders in the service system.

Each county, in order to implement the Behavioral Health Services Act has to create a three‑year implemented plan, we’ll go into that a little bit more. The plan covers years 2026 through ’29 and have been submitted to ‑‑ this should say the Department of Healthcare Services than BHBA and it should happen tomorrow and I haven’t seen a plan yet but I’m waiting until tomorrow to click on the plans that the counties have developed to come up with ways to serve clients in these areas.

CLAUDIA CENTER: Okay. So this is me to start. This is our effort to provide a visual of where we are right now with county mental health systems and all those housing supports that I talked about when I went through the training topics.

So, on our left, we have a box that says county services and supports paid by Medi‑Cal and BHSA dollars. So that’s all going to go through the counties. And then the county itself runs its own mental health plan, the county mental health plan. But then there are also Medi‑Cal‑managed care plans. And so it’s quite complex. The county mental health plans handle full-service partnership, which is one of our training topics, and housing intervention. So, those are two of the supports that include Behavioral Health Service Act dollars. And then the Medi‑Cal managed care plans handle the housing support plan, with the four housing supports. And I know it’s confusing, because a lot of the words are similar. But this is Medi‑Cal dollars, that upper right box, with housing support plan with four housing supports.

And what the Department of Healthcare Services has said, which is a challenging goal, but one that we’re going to hold their feet to the fire, is that the County Mental Health Departments or Behavioral Health Agencies and the Medi‑Cal managed care plans are supposed to do coordination and braiding; in other words, they are ‑‑ even though they are different entities, technically, they are supposed to coordinate these supports and services so that everyone who is high need for mental health and housing, which are, you know, mostly CARE Court respondents, you know, meet all these criteria, are to get all of the supports on this page. Even if they’re in different boxes. So, that’s what coordination and braiding means. We think. Kim, I wanted you to chime in here too.

KIM SWAIN: I think that covers it. I mean, I think the thing that makes California  unique and complicated is that what the State does is it really allocates almost all of its  responsibility and dollars back to the county. So, as advocates in a specific county, you need to be familiar with how your county operates. What damage care plans are in your county. How your county Behavioral Health Department and what services are specifically available in your county.They can look really different from county‑to‑county. So.  that is, you know, 58, but a little different ways of delivering services.

CLAUDIA CENTER: And if you’re ever confused, just focus on the behavioral health agency or the mental health agency, because ultimately, they’re responsible.But depending on your facts, you may be interacting, to some extent, with other entities and contractors. So, we’re going to start with the Medi‑Cal housing supports. So this is the housing plan with the four housing supports. This is brand new.

So, the criteria for these housing supports are as follows. And we have the citations at the bottom in case you are going to be writing a demand letter, you might want to cite to some of these. So, you need to be ‑‑ have homelessness or risk of homelessness, and the person has to meet the criteria for specialty mental health services. Which is a higher level of care for people with significant psychiatric conditions. And how the specialty mental health services eligibility works is that you need a functional impairment due to a mental health disorder, with significant impairment in social, occupational, or other important activities. Or the reasonable probability of significant deterioration in important areas of functioning. So, you know, this is going to be, anyone who is in CARE Court or maybe mental health diversion, the typical profile is going to match this very closely. And now I’m going to pass it back to Kim.

KIM SWAIN: So the way that the program is set up is that the housing supports that are in the state plan need to be provided through the Medi‑Cal managed care plans or their contractors. So, managed care plan, like, it could be your county plan, it could also be Kaiser, if they accept Medi‑Cal clients, or Blue Shield, it could be another plan, depending how your county is set up. They need to provide these housing services. And the four ones that are required or currently available are housing navigation services, which help people to, let’s say, apply for, identify secure housing. They could develop a support plan. Educate a landlord about a specific tenant, and find other resources to help you pay for housing. Gets you through the housing system.

The second one is to provide housing deposits, which can be used for things like security deposits, applications, utility set‑up fees, last and first months’ rent, et cetera. Transitional rent, which I will come back to in a second. And housing tenancy and sustaining services, which is usually some counseling that helps you keep your services or referrals to a community legal aid, if you were getting evicted, help with the recertification process for Section 8, et cetera.

The big one that is the newest one and probably the one that is ‑‑ has the most teeth and provides concrete housing resources is transitional rent. That started with the managed care plans on the first of this year. And will be included as continuation funding in those integrated plans through behavioral health that we talked about a moment ago. In order to get transitional rent, you actually ‑‑ it’s a mandatory service. So all of the counties have to provide it. And all of the counties have also opted into these other three housing support services. So, these should be uniformly provided throughout the State of California, in all counties. In order to get the transitional rent benefit, however, you have to have a couple of other additional criteria. And those also are probably met by your clients. You have to be coming out of an institution or jail; you have to be homeless or unsheltered; or you have to be eligible for a full service partnership. So, they’re really trying to keep this benefit of actual dollars to pay for rent to be going to people who are homeless and people with significant mental health disabilities. That’s it. So, the way you access these housing support services is through the development of a housing support plan. And the plan can be developed by the managed care plan or any of its contractors. It could also be developed ‑‑ I just found out by reading up on this ‑‑ it could be developed by a community group that does housing advocacy. As long as it meets the five criteria that I will go through in a minute, that’s set forth by the Department of Healthcare Services.

So, the whole purpose of a plan is to provide a roadmap for people who are homeless, to be able to move into ‑‑ move from homelessness into permanent, stable housing. So, the plan has to have five different components. First of all, it has to identify the permanent housing strategy and solution. And not just in the abstract, but specifically the payment resources, the mechanisms that could support the client or the member of the managed care plan in maintaining their housing after Medi‑Cal services are exhausted, like, after the six month transitional rent period. Which for most of these clients would mean that the county behavioral health would pick up the services or the rent subsidy post the six month period. It has to identify supports that were needed in that permanent housing situations to sustain the tenancy. It has to be client‑centered and informed by the client’s preferences and needs. So, say, for example, you had a client who was really had difficulties living in a group setting because they had difficulty getting along with people and had thrown out of group homes and wanted to live in different kinds of settings. One of the things that should drive the housing support plan is what the individual wants and their needs and they want to live in an individualized apartment or supporting housing situation that didn’t involve living in a large congregate setting. And it has to address the goals and barriers, et cetera, that this individual has ‑‑ has confronted. And that it has an approach to meeting those goals. It has to be culturally appropriate and trauma‑informed. And it also has to be updated, when necessary, and regularly. So, say someone’s first housing support plan might just deal with interim housing or emergency housing; once that has taken hold and the person/the individual is ready for moving into a more permanent situation, the housing support plan should be updated to evolve with their needs until they are actually able to secure permanent housing.

CLAUDIA CENTER: Okay, this is back to me. And we promise we’ll review how these all intersect. But full service partnership has been around for a while. And I definitely talked to CARE Court counsel will full service partnership in the past, it’s been around for a while, and the concept is it’s a partnership between the client and the service provider, in which the client is offered an array of services and theoretically the county is supposed to have a “whatever it takes” approach to meet the needs of the client. It is designed for people with significant mental health at risk of unhoused, unhoused, have a risk of legal involvement, or have repeat hospitalizations. It requires a serious mental disorder and a high level of functional impairment. And as we will see, the characteristics of CARE Court respondents closely correspond to the FSP criteria. And as an advocacy matter, in my opinion, to get your client accepted into full service partnership can be helpful, because that level of need will then translate into the same ‑‑ into that you’re qualified for all the other things that we’re talking about today.

You don’t have to be in full service partnership to get the other things that we’re talking about, but if you get your client approved for FSP, it’s sort of, okay, you’ve met the criteria for everything else. So that’s another reason why it can be helpful. So here’s a little bit about what is a serious mental disorder under the FSP Welfare Institutions Code which is cited here. You need a serious mental disorder, meaning severe in degree, persistent in duration, and there’s a list of what these conditions include, which includes schizophrenia bipolar disorder, and obviously that’s going to match up with CARE cort, which is schizophrenia spectrum and other psychotic disorders and bipolar I disorders and we have a clear match there. And then the criteria in addition to the mental disorder is a substantial functional impairment or symptoms. So, again, this is  similar to the specialty mental health services. Standards is just a bit more severe, that you have to be substantially impaired in independent living and social relationships and physical skills and physical condition and likely to require public assistance services or entitlement, unserved or under served and homeless or at risk. Involved in the criminal legal system, or institutionalization or frequent user of hospital or emergency rooms. So all of those risk factors which are common for CARE Court respondents. And so if you look at the CARE Court criteria, it’s, you know, analogous that the person is not clinically stabilized, unlikely to survive safely in the community without supervision, is substantially deteriorating or needs services to prevent deterioration, that would result in being gravely disabled, which we know it has been expanded to include the inability to provide for their necessary medical care, or serious harm to the person or others. So, the Venn diagram is very close.

KIM SWAIN: So how are full service partnerships funded? The Behavior Health Services Act, as I said, was State money, that million dollar tax, can be matched with Medi‑Cal money to draw down federal monies to pay for services. Or for those services might not be covered under Medi‑Cal or those not met by being under Medi‑Cal, those dollars can be used separately from State‑only dollars. Medi‑Cal goes first, basically. So those housing services that we talked about before come first and then behavioral health services dollars, State‑only dollars, should be used primarily only when the member or the client can’t get their services through Medi‑Cal first. Full service partnerships are not entitled to ‑‑ oh, and to the extent resources are available. So, what happens with Behavioral Health Services Act dollars, and full service partnerships, they usually have a specific number of slots in each county, like, say there’s 200 slots or 100 slots. Beyond that, it’s not necessarily an entitlement to the extent that the resources are not available, there could be caps on services.

However, if it’s funded by Medi‑Cal and there is services available or someone is to be terminated from services, we would always make the argument that we’re using Medi‑Cal dollars to fund full service partnerships, it also comes with the same due process rights and protections that come with all Medi‑Cal services. So, as Claudia said before, sometimes this is braided money, sometimes this is individual money, that’s State only. But if it’s blended with federal dollars, then we would make the argument if someone is terminated from an FSP program or not found eligible for one and there are slots available, I think there is a good argument that you could ask for a ‑‑ file a grievance and then ask for a state‑level fair hearing to determine whether or not someone should be entitled to those services.

CLAUDIA CENTER: So, who decides who gets an FSP slot? And really, it’s pretty squishy. There’s no strict rules on how the county can decide who gets an FSP slot, other than prioritizing people who are unserved. So, really advocacy can make a big difference here. You can be a pain in the butt and send letters and say that your client needs FSP and, you know, you have got a good chance of getting your client into an FSP slot, and that can help open the door to these other services. Also, you know, if you look at what the state policy is for Behavioral Health Services Act and FSP, the State is telling counties to serve people, like CARE Court clients, with these services. And the State is putting a lot of money behind it. So it’s clearly state policy for CARE Court respondents, maybe people in mental health diversion, to be at the top of the list for these services. So, you should feel very assertive in making sure your client gets into an FSP slot. The county must periodically report to the Department of Mental Health on the clients served by FSP and how there are selections for filling those slots reduce disparities. But, again, it’s not a very hard and fast selection process.

So, why are we even talking about FSP? The reason why we’re talking about FSP, because of those Behavioral Health Services Act dollars has a lot of flexibility about what it can provide. It can provide all of those mental health supports, like mental health treatment and peer support and case management and crisis intervention, all those things. The FSP can make sure that the client has access to those. But it also includes non‑mental health supports, like food, clothing, and housing. So even before all these new changes that we’re talking about today, FSP already had said in its regulations that it could support housing. So, you can use this regulation in your advocacy, along with all the other cites we’re providing for housing supports.

KIM SWAIN: So one of the questions I always asked was, like, the full service partnership says ‑‑ the statutes says do all that it takes to provide supports to people. And then when you get down to the advocacy, it’s, like, what are they really providing? So, Claudia went through the list of things they could provide. But in general, the way they do provide these services in different counties, is through a variety of mechanisms. One is it could be a multi‑disciplinary team staffed by the County Behavioral Health Department. That’s becomes less and less common.

The County Behavioral Health Department could also contract with either non‑profit or for‑profit providers, like Turning Point or some of the non‑profit providers, like DHCS in the Bay Area or for‑profit like telecare that provides wrap‑around services, either intensive case management or ACT services. And the service model that is used usually to support the FSP‑level clients are either in intensive case management teams or what’s called ACT or forensic ACT programs, and this is an assertive treatment program and they have much more robust staffing, usually 1‑10 ratios. They’re a team of professionals, multi‑disciplinary teams. They are specifically designed to serve people who are at risk of psychiatric hospitalization, homelessness or involved in the criminal justice system. They have a team which is responsible for providing services in the community 24/7  crisis coverage to keep people out of jail and out of institutions. And they provide the whole range of services, med management in the community, crisis intervention, housing support, vocational training, counseling, substance use, all as part of their professional team. So, they really are a model that is a hospital without walls. They’re really meant to be to really do all that it takes to keep people in the community and out of institutional settings. And they are voluntary.

CLAUDIA CENTER: And I think you told me, Kim, that they were designed specifically for people with schizophrenia.

KIM SWAIN: Yeah, I mean, California’s really moving away from the full-service partnership squishy language and trying to get the counties to be a little bit more evidence‑based practices, use evidence‑based practices. And ACT is one of the evidence‑based practices where they really show it’s most effective with people who are labeled as schizophrenia or bipolar who are really not able to really engage in some of these other systems. It’s bringing the services to you, as opposed to you have to walk into a clinic and set up a meeting with a county social worker. So they’re really designed to deal with people with, you know, specific, harder to treat issues.

CLAUDIA CENTER: So, remember from one of our first slides with the training topics, we were talking about the new things. So, one of the new things is the Behavioral Health Services Act housing interventions. And these are supports that come in to support an eligible person who’s going to be a person who’s homeless or at risk of homelessness with a significant mental health disability. And these housing interventions come in after the Medi‑Cal supports are exhausted. And so then these dollars come in for this high‑risk population.

So, according to the Policy Manual and the FAQ from the Department of Healthcare Services, the housing interventions must comply with a housing‑first model. It must include access to behavioral healthcare, but it need not be located in the same place as the housing itself. The priority populations – this is going to look very familiar to all the other standards we’ve talked about – homeless or at risk of homelessness plus interaction with the criminal legal system or at risk of conservatorship or institutions. Again, it has to complement the Medi‑Cal housing supports, the four supports. These housing interventions cannot be used on supports that are covered by Medi‑Cal. And then the most important thing to know is that this includes a permanent rent subsidy for people who meet the criteria. And that is in these documents that we’ve cited, that BHSA housing interventions’ funding is intended to serve as a permanent rental subsidy for housing. So, you know, that’s a big deal.

KIM SWAIN: Can I just add a couple of other things, Claudia, of what might be covered?

CLAUDIA CENTER: Yes, please.

KIM SWAIN: This is definitely supposed to fill in the gaps of what is not covered through the managed care plan, Medi‑Cal housing support provision. So, it could include things like moving costs, utility assistance, covering pet fees, covering, like, damages to an apartment if someone needed to reimburse a landlord. Paying for landlord incentives or landlord holds, if someone is temporarily unable to be housed, for a variety of reasons. And then doing actual outreach and mitigation efforts to keep landlords in a landlord/tenant subsidy program. They’re really broad in terms of what they can do, and so those are some of the other specific things that are mentioned in the guidance from the Department.

CLAUDIA CENTER: Yeah, these documents, I mean, they’re newish, and they’re really important and, you know, they set a pretty high standard for the counties, and that’s why we’re really ‑‑ we think it’s urgent to educate you all about these standards so that we can all try to enforce them. Because, you know, it’s gonna be an effort.

So I think, you know, we’ve already said this, but I’m just going to repeat it one more time, that what the Department of Healthcare Services is telling the counties and the managed care plans, is they have to work together to effectively braid and sequence the housing‑related community supports, so that’s the Medi‑Cal piece. And the BHSA housing interventions, that’s the state dollars Prop1 piece. DHCS expects coordination and collaboration between counties and managed care plans to ensure the clients get housing supports benefit and the housing interventions and they get the Medi‑Cal for the housing plans for support and get the housing interventions which is what Kim mentioned as the subsidies.

KIM SWAIN: So, as we talked about the integrated plan is the document prepared by the County Behavioral Health Department, which is going to take all that money from ‑‑ all the money that it gets from a variety of different sources, including Prop1 and the whole millionaire 1% tax, and all of the other funding sources, which you don’t really need to know what they are. Put them into one big three‑year plan and describe how they’re going to use all of their available funding to meet local needs, reduce disparities, and meet the unmet needs of their community.

So, in those integrated plans that your county should be coming up with by tomorrow, you should be able to provide some good information about what services will be funded, maybe a list of what providers are going to be providing those services, which ones might be phased in, in year one, year two, year three. How many slots there are for full service partnerships, whether there’s any dedicated for forensic clients and those should be a treasure trove for all of that

CLAUDIA CENTER: And in DREDF, once we start getting a handle on these integrated plans, we may be able to, if you struggle to understand what’s in there, we may be able to help you untangle it. You know, we have to wait and see what they look like, but please reach out.

KIM SWAIN: So I think that all of this is a lot and confusing. And so I think that the one practice tip I have for people is that while there’s 58 counties, 58 flavors, and as statewide advocates, we need to understand how all of these things fit together. There’s small, there’s large, different funding formulas and different requirements for all sorts of different counties throughout the state. You only need to understand how your county works. Your county will have managed care plan, they will have an integrated plan that will drive their County Behavioral Health Department, so you need to, like, understand what your managed care plans are and who ‑‑ what they are and what client matches up with what managed care plan, how your county might handle housing navigation or some of those initial services where you can get a housing plan developed. And what are your best options in your county for FSPs. Who are the providers? ACT? Outreach? Supported housing? Rental housing subsidies? The more you know, the better advocate you will be.

If you can click on each county button for a second, Prop1? Just click on Alameda, for example. Prop 1 was set up and trying to make it easier, they’re trying to integrate managed care and behavioral health.

And they’re really trying to take those services and make it so that people can access those seamlessly. We’ll see how, you know, it’s going to be bumpy. But, each county will have a page. And on that page, you should be able to click to it and you will be able to see who your behavioral health plan department is on one side. All the behavioral and all the managed care plans on the other. In some small counties, it might be one managed care plan. In larger counties, like L.A., there might be six managed care plans.

So, if you want to find out how your county is set up, some of the smaller counties only have a county plan. So, hopefully those will be much easier to, you know,  operate between the behavioral health and the benefits that are available through the managed care plan in the housing arena.

So, if you click on the integrated plan piece, it says today that Alameda County submitted its draft plan in March. And that it is pending approval. So, hopefully by tomorrow, it will be approved.

And my understanding is that this website will be populated with as much information as it becomes available. It’s rolling out in phases, so hopefully it will be one-stop shopping for your integrated plan, information about your managed care plans, information about services that are available in your county and who is getting provided with those services. So, I just wanted to show you the portal, because I thought it was nifty. If they keep it populated, it will be a really good tool.

CLAUDIA CENTER: And even now you can see what managed care plans are in your county.

Okay. So we’re going to go through a housing advocacy letter. You know, this may not be, you know, you might not use this word‑for‑word, but this is, like, how we would organize advocacy, like, how to approach your advocacy with the county, and then, you know, you would then elevate that advocacy to the judge in CARE Court.

So, basically you would be communicating with your county behavioral health administrator and the county behavioral health agency. That’s a live link, I won’t click on it now, but that’s a live link to a page maintained by the Department of Healthcare Services, that for each county lists the staff and the address of the county behavioral health. And so this letter would say my office represents the client name who is participating in CARE Court proceedings in such and such superior court. I am writing to request that the county mental health agency coordinate with me and my client to ensure that they are provided with: And then below we have the three most important supports for housing. And actually the full service partnership is important for other things too, but today’s training is about housing. So, one is wrap‑around services through a full-service partnership.

Two, is a housing support plan with housing supports. That’s that Medi‑Cal that we talked about with the four supports. And three is the housing interventions. The supports that come in after your Medi‑Cal is exhausted.

So, this is how you would pitch the fact that your client is eligible and should be given an FSP slot. My client is currently struggling with severe behavioral health challenges that despite, and you might discuss some of the current services and treatments, have not been stabilized. In other words, the idea is that what you have now is not working. Your client meets the criteria for intensive wrap‑around services provided by an FSP team. And then you would  go through those elements of who’s eligible for an FSP. So, a severe serious mental disorder. My client has a serious mental disorder that is severe and persistent. That’s the phrase from the statute. Their condition substantially interferes with their functioning and activities of daily living, such as… you want to give concrete examples of how your client is really struggling. They are unable to maintain stable functioning or basic stability without intensive treatment and support for an extended period of time.

And, again, anything to describe how your client is struggling and how what’s happening now is not working is what you want to put in there. Be, you know, concrete.

Then you want to describe some of the high-risk factors that are in the regulations for people who get an FSP slot. So, my client has multiple risk factors that contribute to their need for services at the FSP level of care. And so these are homelessness or risk of homelessness, this is contact with law enforcement, or incarceration, or, you know, repeated interactions with criminal legal in any way, shape, or form. Psychiatric hospitalizations. And the use of hospitals and emergency rooms, especially repeatedly. Those are some of the risk factors that are described in the regulation.

And then third, just the current need, and this is  you have already done it, but explain why the standard outpatient treatment that your client’s been receiving, it could be just ordinary Medi‑Cal, it could be the county could have put them at specialty mental health services, but you want to get to the highest level of care, which is full service partnership. And so here, if it’s relevant, you might describe the circumstances that led to the referral to CARE Court, because that might show why FSP is needed.

Kim, anything here on the FSP advocacy?

KIM SWAIN: No. I just can’t help but, like, in my brain start thinking about things, like, voluntary versus involuntary, and full service partnerships are voluntary services. So, obviously  which service you take within the full service partnership is probably also voluntary. So, as we said, it provides a lot of things. It could provide better management but also provide housing and finding a job and provide a variety of different things, full service partnerships. So, it might be good to set some of those things out with your client. If they should be doing robust outreach and engagement, the full-service partnerships as well, so the point of it is it’s a service that people should want to participate in, because it is driven by ‑‑ it’s a client‑driven service.

CLAUDIA CENTER: So, now we’re going to move to the second of our three, you know, things that we think you will want to advocate for for your client. So, my client is covered by Medi‑Cal and is currently, you know, either experiencing homelessness or at risk for homelessness or marginally housed; that’s a requirement for these housing supports. My client needs immediate housing intervention to maintain or secure housing and stabilize the behavioral health condition. My client meets the requirements for needing housing supports based on their serious mental disorder and housing status.

And then, we don’t think the counties really know all the rules yet, so we are encouraging that you might cite to some of these new policy guidances and you probably are going to want to cite to them to the judges as well. I request that the county develop a housing support plan for my client that includes the following housing supports. And we just listed all of the four housing supports, and your client may only need some of these. But we just listed them here.

As the policy guide makes clear, my client’s housing support plan should include the following elements and characteristics. So these are the ones that Kim went through earlier that there should be an identified permanent housing strategy and solution. Basically, payment sources and mechanisms to support the client in maintaining housing permanently, not just for six months. Permanent supports for sustaining tenancy.

Client-centered, we’re going to talk about this on the informed by the client’s preferences and needs. Individualized housing assessment, addressing the client’s barriers and goals and identifying what providers and services may be needed. And culturally appropriate and trauma‑informed, which we’re not sure we’re going to be able to do that one, but you can ask for it; it’s in the policy. So, here we wanted to focus on what your client needs and wants with regard to housing. And Kim mentioned this before.

A lot of counties, like Alameda County, all they’re going to offer in CARE Court is board and care, which is a congregate setting, and some CARE Court clients cannot live successfully with other people. And so you want to talk to your client about what housing has worked for them, when they haven’t done well in housing, and try and figure out what would meet your client’s needs.

So, if you wanted to, in your advocacy, you wanted to describe the housing that your client wants with concrete reasons for the preferences. And one practice point that we have, and I’ll have Kim weigh in here, is that you might want to take a look at your county’s integrated plan and take a look at the housing sections. You might want to ask your client, you know, “Have you ever lived, like, what  housing has worked for you in the past? And do you know what program that was?” Or ask or just try and get familiar with the different housing programs in your county and their characteristics. You could look at behavioral health bridge housing, behavioral health bridge housing, housing projects, to get a sense of those, because those often include, like, tiny homes and apartments. But just get a sense of what exists in your county? And, you know, we’ve said this already. And it can be tricky. The integrated plan is supposed to make it more transparent but, you know, we don’t know what they’re going to look like until we can see them. Because one of the things that we want is for people to get housing that will work for them.  So I’m going to pause and let Kim chime in here.

KIM SWAIN: I think that’s ‑‑ I guess the only thing I would add is that the dealing with the crisis of being homeless might look different than what you could ‑‑ you’re eligible for and get down the road. So it might be a temporary situation that isn’t completely ideal, but that what you’re working for is, you know, the slottedness and supported housing for the rental program that might become available in a few months. So,  looking at it with an eye toward two parts, you know, solving the interim problem and the long‑term problem. Sometimes those are the same thing and the funding can just be seamless, going from one to the other, if you happen to be lucky enough to be able to secure your permanent housing solution. But oftentimes, they aren’t, that’s not the way the county sets things up. And the BHBH housing I think is mostly bridge housing for getting you into something now and onto ‑‑ into something else on a more permanent basis. So, understanding that certain funding sources and the way they set up the system creates this two‑step process.

CLAUDIA CENTER: And but one thing that’s helpful about ‑‑ I don’t know how many of you do, like, disability rights in your advocacy, but when you talk about, like, reasonable accommodation or reasonable modification, what you ask for has to be feasible for the covered entity to provide.

Now, it could be something new that they’ve never done before, but it still has to be feasible. And so some of the way that you can understand what’s feasible in your county is to sort of understand what exists now. That doesn’t mean you can’t ask for something that doesn’t exist now, but what exists now can show you what’s feasible and be really persuasive with the judge, I think.

So, now the third big support for your client is the housing interventions. So my client is also entitled to BHSA housing interventions after their head cal housing supports are exhausted. My client’s within the priority population for housing interventions set out in the policy guide. They are homeless or at risk for homelessness and then have the risk factors, the interactions with the criminal legal system, risk of conservatorship, risk of institutionalization. And then in accordance with the policy guide, I request that you integrate the BHSA housing interventions, including a permanent rental subsidy to ensure my client’s permanent housing, and it could be other things like Kim mentioned. The housing interventions, because it’s not Medi‑Cal dollars, there’s really no limit, as long as they are part of supporting the client’s housing.

So, then you’re going to say, you know, given my client’s urgent situation and complex needs, we request a meeting to discuss this plan within such and such days and thank you for your prompt attention to this matter, et cetera. So, you know, some of this advocacy could be you might be doing e‑mails and phone calls first and then a letter or you could be doing different things depending on how things play out. But these are really the three main supports that CARE Court clients should be eligible for in most cases, and are backed up by a heck of a lot of dollars.

And so when you go to the judge, I think if there’s pushback, I don’t know, you might mention, you know, the State of California has thrown billions of dollars at this and, you know, the county is supposed to do it. And again, it has to be feasible. You want to see what’s available and it has to be something like that or similar or, you know, within that reality.

PETER TALKINGTON: All right. Thank you, Claudia. So, I know we’re running out of time, so I won’t be too long. Like Claudia said, a lot of you probably have already heard of the behavioral health bridge housing or the BHBH program. So, the program was signed into law in 2022, and it is a one‑time dispersion of funds to tribal counties and entities to bridge housing, temporary house from which a client would ideally move into permanent housing or long‑term housing. So, the program is managed by the Department of Healthcare Services, DHCS. They distributed about a billion dollars, a little over a billion dollars, to counties and tribal entities. A vast majority of that to counties, starting in 2023. And the program goes until actually a year from today, June 30, 2027 is when the funds expire.

So, all but two counties in California got funding. Those two counties that didn’t are Alpine and Plumas, small counties, and pretty much every county in California got to set up the BHBH beds. And that’s important and as you can see on the slide, CARE Court clients have priority to these BHBH beds. They should be automatically connected to BHBH housing, if that’s part of their plan. But we’re not sure this always happens. So, we are going to try to track down where all the funding is going. It’s not entirely clear. DHCS keeps track of the counties but every county has discretion to operate the program. Some counties operate it themselves and operate the shelters, but most counties contract out to non‑profits and assisted living facilities to operate their BHBH beds. And what organizations they contract with can be hard to find.

So we reached out to every county and some were nice enough to respond to my e‑mails; others had to send in a Public Records Act request. We heard back from all but a couple counties. And we compiled all of that data in the sheets here. Or we have a sheet on our website, it’s that last link on the slide. And then you can see DHCS’s own data on those top two links. But if you look at our sheet, the data is all over the place. Some counties’ responses were much more detailed than others. Some of the information we’ve learned from advocates isn’t entirely accurate or it’s out of date or it’s incorrect. But, again, like I said, ideally, if your client needs BHBH housing as part of their plan, they should be automatically connected. If not, you will see in our sheet we have contact information for most counties that you can reach out to, and they should help your client get connected to housing.

And just the last thing about that is that you heard Kim and Claudia talking about the Behavioral Health Services Act, BHSA. Obviously a portion of that has to go to housing, so some of that funding can be used for ‑‑ to fund one‑time housing supports, including BHBH, as well as a number of other housing programs. And so if your county is choosing to use some BHSA funding to fund their BHBH program, hopefully that should be detailed in their integrated plan. Now, like I said, the BHBH program expires about a year from today, and so it’s not entirely clear if your clients would still have priority in any BHBH beds that the counties choose to continue to operate after that date. My guess would be not. But at least for the next year, you know that CARE Court clients have priority in BHBH beds.

ABI: Yes, so thank you so much to Claudia, Kim, Peter, and DREDF in general, for this amazing presentation Y’all have DREDF’s information. We will be providing the content and materials at a later date. But you will be getting that e‑mail from us.

And please stay tuned for Part 2 of this amazing series that we have in partnership with DREDF.

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