State and county experts urge outcome‑driven overhaul of full service partnerships as Prop 1 reshapes funding

A commission panel on full service partnerships — intensive, community‑based programs for people with serious behavioral health needs — concluded that the programs are effective but inconsistent across counties and need major system changes to scale and standardize benefits under the Behavioral Health Services Act (Prop 1). The Mental Health Services Oversight and Accountability Commission convened representatives from 3rd Sector, the Department of Health Care Services (DHCS), the Healthy Brains Global Initiative and county behavioral health leaders to map next steps.

Panelists said the evidence that FSPs improve housing stability, reduce hospitalizations and lower criminal justice contact is strong, but delivery varies widely. “There is no doubt that FSPs save lives,” said Richard Johnson, chief executive of the Healthy Brains Global Initiative, summarizing field interviews and site visits his team conducted. He and other presenters said lack of transparency and standardized metrics make it hard to identify top performers or to scale what works.

Why it matters: Prop 1’s Behavioral Health Services Act creates funding and statutory changes intended to expand and standardize high‑quality care statewide. Tyler Sadwith, state Medicaid director at DHCS, told the commission that the BHSA and related reforms evolve the Mental Health Services Act and add substantial facility and workforce investments — and create a statutory role for counties, the department and the commission to define FSP levels of care and reporting standards. “The behavioral health transformation … provides about $4,400,000,000” for facility expansion and prioritizes scaling evidence‑based models, Sadwith said, adding that the state will develop centers of excellence and data reporting to support counties.

Key recommendations from the panel: adopt a common set of consumer‑centered outcomes; invest in interoperable, clinically actionable data; support peer‑to‑peer and culturally responsive services; pilot pay‑for‑outcome approaches; and reduce administrative burdens that drive case managers away from direct care. Emily Melnick of 3rd Sector, which ran statewide stakeholder engagement, said providers asked for “concrete and directly actionable tools” rather than high‑level guidance, and recommended aligning on a small set of core metrics across programs.

Operational hurdles: County leaders described capacity and workforce shortages, housing scarcity and data fragmentation. Susan Holt of Fresno County said Fresno is piloting continuum‑of‑care contracts with separate budgets for step‑down services so people can 'graduate' from FSPs without losing relationships with trusted providers. Dr. John Sharon, HBGI’s chief medical officer, argued payments should reward outcomes rather than billable tasks: “Outcomes of human beings must drive our system,” he said.

Next steps and what to watch: Panelists and commissioners called for pilots that remove billing constraints, trials of value‑based payments (CalAIM behavioral health payment reform was cited as a lever), clearer procurement pathways for innovative providers, and better monthly performance monitoring so counties and funders can compare programs in real time. The commission will be asked to help define FSP levels of care, evaluate monthly performance data, and use its $20 million annual innovation fund to seed pilots and learning collaboratives.

The commission’s discussion closed with a public reminder that implementation will hinge on aligning payers (Medi‑Cal managed care), county systems and community‑defined practices while protecting culturally responsive programs as funding and rules change. The panel urged a deliberate, field‑informed rollout so counties can scale effective, equitable FSPs without undermining local innovation.