Grand Jury Conclusion Unexpended Mhsa funds are subject to reversion to the State, unlike most other County

Underspending of MHSA funds is a State-wide issue, although a few counties have managed to fully utilize funds provided under this program. The Board of Supervisors agrees with the finding.

The County’s MHSA Project Team has taken some actions to minimize the risk of reversion of MHSA funds. The Board of Supervisors agrees with the finding. Specifically, MHSA Innovation funds have been at risk of reversion, and the MHSA Project Team has recommended adding one new project, expanding an existing project, and opting into two statewide Innovation projects for FY 2019-20 to address local needs while spending down at-risk funds. These are all still pending approval from the Mental Health Services Oversight and Accountability Commission (MHSOAC).

There are systemic and persistent issues in hiring and retaining County mental health employees that impact the timely expenditure of MHSA funds. The Board of Supervisors agrees with the finding. The Health and Human Services Department reports the following status of recruitment and retention efforts, as of May 2019: Since 2016 Behavioral Health has conducted 38 recruitments and has had 30 o separations. Overall, the Department has experienced a 109% turnover in Mental Health Clinician positions. Behavioral Health had 18.5 filled Clinician positions and 12 vacancies. o 12 of the 18.5 filled positions were still interns and not qualified for professional o licensure yet. Statewide there is a shortage of medical professionals and there is increasing o demand for licensed mental health clinicians.

The El Dorado County budgeting philosophy puts County MHSA funds at risk of reversion. The Board of Supervisors disagrees with the finding. The County budgeting approach is to represent the full obligation and anticipated revenues for all County programs and services. If the Department were to budget at less than the County’s obligated expenditures, this could lead to financial and budget complications during the fiscal year. Furthermore, actual expenses are not influenced by the County budgeting approach, but by other challenges that are described in the Grand Jury Report. Through the county budgeting process, the Department budgets 100% of anticipated annual plan expenditures, based on the approved plan budget. Due to a variety of reasons, including vacancies in budgeted positions, expenditures rarely reach this level, creating “plan savings.” The Department uses forecasting tools separate from the annual County budget, and holds routine discussions regarding how to manage and use plan savings.

The County’s contracting procedures are complex and time-consuming. This allows less time for contractors to assist staff in developing and implementing programs, putting County MHSA funds at risk of reversion. The Board of Supervisors agrees with the finding. Due to contracting processes that are required to be followed by public agencies, as well as the complexity of developing and implementing new public service programs, it can take several months to conduct a competitive procurement process and at times additional months are needed to negotiate and execute final contracts. Once contracts are in place, additional start-up time is necessary for contractors to build and implement programs for MHSA.