DATE:
August 26, 2025
24
TO:
Board of Supervisors
SUBJECT
Title
ADVANCING EQUITY THROUGH AN AD HOC SUBCOMMITTEE ON SAFETY NET SERVICES AND BEHAVIORAL HEALTH SYSTEMS TRANSFORMATION (DISTRICTS: ALL)
Body
OVERVIEW
San Diego County is at a critical inflection point in the evolution of its health and social services systems. Two concurrent developments demand focused, expert-driven planning: (1) the implementation of federal H.R. 1, which proposes sweeping changes to Medicaid and nutrition assistance eligibility, and (2) the strategic realignment of the County's Behavioral Health Services (BHS) into a standalone organizational structure. Each initiative carries major implications for the County's operational structure, budget, and ability to meet the needs of vulnerable populations. The convergence of these federal and local policy shifts presents both risk and opportunity-requiring a nimble, systems-level governance structure capable of identifying cross-cutting impacts, maximizing state and federal engagement, and ensuring thoughtful design and implementation.
On December 10, 2024 (32), the Board of Supervisors (Board) authorized a comprehensive assessment of the Behavioral Health Services (BHS) Department to optimize its role as a health plan, ensure effective service delivery, and strengthen system-wide integration. This action also directed an assessment of the potential impacts on the County's Health and Human Services Agency (HHSA), recognizing the interdependencies between behavioral health, public health, and social service functions. To support this work, the Board approved a competitive solicitation for consulting services to conduct the assessments, analyze operational models, and identify strategies to enhance efficiency and outcomes.
Since that action, it has become clear that, in addition to the original Board direction, a more structured governance framework is needed to collaborate with the Chief Administrative Officer and any contract...
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