The California Department of Health Care Services (DHCS) and the California Department of Social Services (CDSS) launched two new programs expanding behavioral health (BH) and long-term care infrastructure:
- The Behavioral Health Continuum Infrastructure Program (BHCIP)
- The Community Care Expansion (CCE) Program
The programs intend to address historic gaps in serving seniors, people with disabilities, and people with behavioral health needs.
Both grants afford county and Tribal entities the ability to expand the entire continuum of care for people with BH conditions.
Background
DHCS will release funding through six grant rounds targeting gaps that have been identified in the state’s BH facility infrastructure.
BHCIP released two rounds in 2021 including:
- Round 1, Mobile Crisis. $205 million
- Round 2, County and Tribal Planning Grants. $16 million
The remaining BHCIP rounds to be released in 2022 include:
- Round 3, Launch Ready, $518.5 million
- Round 4, Children and Youth, $480.5 million
- Round 5, BH Needs Assessment Phase One, $480 million
- Round 6, BH Needs Assessment Phase Two, $480 million
$2.2 Billion in BHCIP Funding
The California DHCS and CDSS, through the Behavioral Health Continuum Infrastructure Program (BHCIP), will award $2.2 billion in grants to qualified Tribal entities, cities, counties, and not-for-profit, for-profit, and private organizations to:
- Plan, construct, acquire, and rehabilitate real estate assets
- Invest in mobile crisis infrastructure to expand the community continuum of behavioral treatment resources
Key Highlights
Applications and budgets are due February 28, 2022. Planning activities need to occur March 1–December 31, 2022.
Funding may be used:
- To identify potential development sites, buildings for rehabilitation or expansion, potential developers, and brokers
- For additional resources for capital, services, site development, and other reviews of resources
- To cover pre-development costs, such as assessing the feasibility of the proposed capital project, legal fees, option fees, architectural and engineering fees, accounting fees, and other costs needed to verify a project’s viability
Launch Ready and CCE Program Capital Expansion Grant Funding
On January 31, 2022, the California DHCS and Department of Social Services (CDSS) released a Joint Request for Applications (RFA).
Applicants must complete the Pre-Application Consultation Survey, which opened February 1, 2022.
The survey intends to determine their understanding of the RFA requirements, which include:
- Facility siting
- Permit and licensing requirements
- Construction plans and launch readiness
- Oversight and management
- Match requirements
- Budgeting practices
Additionally, applicants will be required to discuss how their proposed project meets local or regional gaps identified through an assessment, as well as how it addresses the state’s priorities.
Funding Purposes
Funding will go to the following areas:
- Grants will fund qualified entities to construct, acquire, and rehabilitate real estate assets or to invest in mobile crisis infrastructure to expand the community continuum of BH treatment resources. BH capacity expansion projects should consider the local impact of the numerous BH efforts in California.
- A portion is available for increased infrastructure for people 25 and younger.
Exclusions
Grant funding isn’t available for:
- Debt retirement
- Operational deficits
- Indirect costs
- Partisan activities
- Religious organizations, explicit religious activities, or activities that exclusively benefit the members of sectarian or religious organizations
$805 Million in Community Care Expansion Program Grants
The Community Care Extension (CCE) program was established by Assembly Bill (AB) 172 (Chapter 20, Statutes of 2021), and will provide $805 million for the acquisition, construction, and rehabilitation of facilities to preserve and expand adult and senior care for:
- Supplemental Security Income/State Supplementary Payment (SSI/SSP) applicants and recipients
- Cash Assistance Program for Immigrants (CAPI) applicants and recipients, including those experiencing homelessness or at risk of homelessness and people with BH conditions
Key Highlights
Some key highlights of the CCE grants follow.
Fund Allocation
Funds will be allocated in the following manner:
- Approximately 75% to capital expansion projects including acquisition, construction, and rehabilitation of residential care settings. Grantees may be approved to use a portion of these funds to establish a capitalized operating subsidy reserve (COSR) for these projects, available for use for up to five years.
- Approximately 25% for rehabilitation to preserve settings that serve target and prioritized populations, including $55 million for a COSR for existing licensed facilities, including but not limited to those facilities that receive rehabilitation funding.
A Request for Application (RFA) was released on January 31, 2022 and is currently open for this funding opportunity.
Applications
Applications for CCE capital expansion project funding will be accepted on a project basis and funded on a rolling basis until funds are exhausted.
Liquidations
A portion of the CCE budget includes federal funding that must be obligated by June 2024 and liquidated by December 2026. The exact timeline for obligation and liquidation of funds for each funded project will be provided in the grant award announcement.
Matching Grants
Match guidelines will be set according to applicant type. Services will not be allowed as match.
Match rates for specific entity types follow:
- Tribal entities receive a 5% match
- Counties, cities, and not-for-profit providers receive a 10% match
For-profit providers or private organizations receive a 25% matching in the form of cash and in-kind contributions—such as land or existing structures—to the real costs of the project will be allowed. The state must approve the match source.
Cash may come from:
- American Rescue Plan Act (ARPA) funds granted to counties and cities
- Local funding
- Mental Health Services Act (MHSA) funds in the three-year plan, considered other local sources
- Foundation or philanthropic support
- Loans or investments
- Other sources
$518.5 Million BHCIP Launch Ready Grants
These grants will provide funding to construct, acquire, and rehabilitate real estate assets to expand the BH continuum of treatment and service resources in settings serving Medicaid beneficiaries.
Proposed BH infrastructure projects must demonstrate they underwent a planning process and are ready for implementation.
Applications will only be accepted from projects determined to be launch-ready and submitted according to the timeline in the RFA.
$570 Million CCE Capital Expansion Grants
CCE Capital Expansion grants are for acquisition, construction, and rehabilitation to preserve and expand adult and senior care facilities serving:
- Supplemental Security Income/State Supplementary Payment (SSI/SSP) recipients
- Cash Assistance Program for Immigrants (CAPI) applicants and recipients, including those experiencing or at risk of homelessness
Eligible Entities
These entities are eligible to apply:
- Counties, cities, and Tribal entities
- Not-for-profit organizations, for-profit organizations, and private organizations whose projects reflect the state’s priorities
- Programs serving people experiencing BH issues and committed to serving Medi-Cal beneficiaries
- Entities committed to BHCIP services and building use restrictions for entire 30-year period
Proposed projects need to expand community capacity for serving the prioritized populations. Programs need to serve seniors and qualifying adults with disabilities who require long-term care supports, giving priority to applicants and recipients of SSI/SSP or CAPI benefits who are at risk of or experiencing homelessness.
Eligible facility types are outlined for outpatient services and residential clinical programs on page five of DHCS Behavioral Health Continuum Infrastructure Program CDSS Community Care Expansion Program, Program Update dated January 5, 2022.
Round 3 Eligibility
In Round 3, private organizations—including private real estate developers with related prior development experience, that collaborate with not-for-profit organizations, Tribal entities, or counties may apply.
They will, however, be required to demonstrate a legal agreement such as a memorandum of understanding (MOU) with the county, Tribe, cities, or not-for-profit organization.
Resources
Check the BHCIP County and Tribal Planning Grants FAQ page, or at the BHCIP and CCE Grantee Resource Library.
Compliance
Eligible entities that receive funds under these programs must understand the compliance requirements to avoid termination of the grant, reduction in future payments or funding amounts, and repayment of funds received and spent. These entities also need to implement an adequate system of internal controls to account for, monitor, and report on the use of the funds.
We’re Here to Help
To learn more about the potential funding available, contact your Moss Adams professional. You can also find more resources at our Health Care Practice.
The information in this article is based on the latest guidance available as of the date of publication. We encourage you to visit the websites listed above for the most up-to-date information.