California Department of Health Care Services

Behavioral Health Bridge Housing Program

County Behavioral Health Agencies

Request for Applications

(RFA)

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BHBH Program County Behavioral Health Agencies RFA

I. OVERVIEW

II. INTRODUCTION AND BACKGROUND

III. ELIGIBILITY AND MAXIMUM FUNDING AMOUNTS

IV. PROGRAM DESCRIPTION

V. ADMINISTRATIVE REQUIREMENTS

ATTACHMENT A: MAXIMUM COUNTY FUNDING

ATTACHMENT B: DEFINITIONS

ATTACHMENT C: ALLOWABLE BHBH PROGRAM ACTIVITIES

ATTACHMENT D: APPLICATION QUESTIONS

ATTACHMENT E: BUDGET INSTRUCTIONS

ATTACHMENT F: BHBH PROGRAM APPLICANT ATTESTATION

I. Overview

Opportunity and Focus

This initial round of Behavioral Health Bridge Housing Program funding will provide $907,936,000 to counties for use in the planning and implementation of bridge housing services for Californians experiencing homelessness who have serious behavioral health conditions (a serious mental illness and/or substance use disorder).

Eligible Entities California county behavioral health agencies Application Timeline Applications will be accepted until, April 28, 2023, 4:00 p.m. Pacific Time (PT) Application Form Accessible starting on February 24, 2023, on SurveyMonkey Apply

II. Introduction and Background

Through the Behavioral Health Bridge Housing (BHBH) Program, the California Department of Health Care Services (DHCS) will provide $1.5 billion in funding to operate bridge housing settings to address the immediate and sustainable housing needs of people experiencing homelessness who have serious behavioral health conditions, including a serious mental illness (SMI) and/or substance use disorder (SUD). The program, which was signed into law in September 2022 under Assembly Bill (AB) 179 (Ting, Chapter 249, Statutes of 2022), provides funding through June 30, 2027.

California has provided significant capital funding to create housing and treatment settings in recent years, including through programs such as Homekey, the Community Care Expansion program, and the Behavioral Health Continuum Infrastructure Program. The BHBH Program is designed to complement these capital investments. In contrast to previous capital funding programs (listed above), the BHBH Program primarily provides operational and supportive services funding to expand bridge housing implementation. Bridge housing may be existing settings that are leased or owned by a county behavioral health agency (BHA) or a provider partner and that can convert them into bridge housing on a faster timeline than a new capital project.

The primary focus of the BHBH Program is to help people experiencing homelessness who have serious behavioral health conditions that prevent them from accessing help and moving out of homelessness.

County BHAs applying for funding will be expected to clearly demonstrate how they will reach the historically underserved client populations that are most in need of supportive services.

Table 1. Overview of BHBH Program RFA Rounds

Release Date Funding Amount Eligibility Type February 2023 $907M County BHAs Noncompetitive predetermined funding distribution

Spring 2023 $50M Tribal Entities Competitive Summer 2023 $250M BHAs and Tribal Entities Competitive*0F* FY24-25 $250M BHAs and Tribal Entities Competitive*

* These competitive rounds will take into consideration activities accomplished in the initial grant period that may include but are not limited to the number of bridge housing beds active and the number of individuals served in bridge housing.

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DHCS has engaged Advocates for Human Potential, Inc. (AHP), a consulting and research firm focused on improving health and human services systems, to serve as the administrative entity supporting the implementation of the BHBH Program. AHP has engaged with additional consultants to support BHBH Program implementation and will provide general grant training and technical assistance (TTA) during the application process and throughout the life of the project.

III. Eligibility and Maximum Funding Amounts

BHBH Program funding is divided among multiple requests for applications (RFAs). This RFA is focused on the initial $907,936,000 in funding available to county BHAs. Only the 58 county BHAs in California are eligible to apply for BHBH Program funding through this RFA.

County BHAs may apply for any amount up to the maximum listed in Attachment A. The maximum amount available for each county BHA is based on a $1,000,000 minimum base per county in conjunction with the most current Behavioral Health Subaccount distribution methodology (50 percent) and the most current Point-in-Time (50 percent) funding methodologies. There is no obligation on the part of a county BHA to apply for the entire amount listed for the county. County BHAs are encouraged to collaborate, where feasible, with neighboring counties’ agencies, as well as with area Continuums of Care (CoCs) and other agencies that address homelessness. Counties may work directly with other counties to create regional models. Applicants are required to submit a budget as part of their application.

IV. Program Description

BHBH PROGRAM GOALS/OBJECTIVES

The BHBH Program builds on the California Health and Human Services Agency’s (CalHHS’s) Guiding Principles & Strategic Priorities and enables DHCS and grantees to meaningfully contribute to the implementation of the California Interagency Council on Homelessness’s Action Plan for Preventing and Ending Homelessness in California.

The following priorities drive the implementation of the BHBH Program:

• This is a critical need, and the focus is on immediate and sustainable solutions.

• Collaboration will complement ongoing state, county, and tribal efforts to address homelessness.

• BHBH Program settings will provide supportive services and housing navigation to assist people who have serious behavioral health conditions and are experiencing homelessness.

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POPULATIONS SERVED

County BHAs must serve individuals with serious behavioral health conditions, including SMI and/or SUD, who are experiencing homelessness. (See Attachment B for definitions of “serious behavioral health condition” and “homeless.”)

The passage of Senate Bill (SB) 1338 (Umberg, Chapter 319, Statutes of 2022), which established the Community Assistance, Recovery, and Empowerment (CARE) Program, adds Section 5982(b) to the Welfare and Institutions Code (WIC) to stipulate that CARE Program participants be prioritized for any appropriate bridge housing funded by the BHBH Program. BHBH Program design and implementation efforts will be coordinated with CalHHS and DHCS CARE Program planning efforts to ensure counties prioritize BHBH Program funding at the local level for this population. Counties that have not begun CARE Program implementation efforts may still start BHBH Program activities. However, once the county begins CARE Program activities, the population must be prioritized for BHBH Program-funded bridge housing.

County BHAs should provide BHBH Program bridge housing and supportive services throughout the county, including in rural areas, to enable people to remain in their communities. Additionally, in alignment with the CalHHS Guiding Principles & Strategic Priorities, county BHAs must prioritize addressing the needs of populations disproportionately impacted by homelessness.

MINIMUM COUNTY BHA PROGRAM REQUIREMENTS

At a minimum, every BHBH Program-funded county BHA program must meet the following requirements, which the county BHA must outline in its BHBH Program Plan. Program requirements are not necessarily limited to this list. Additional requirements are identified in Attachment C. Attachment F identifies required attestations.

Administration Requirements

• Designate a program director, project lead, or other point of contact.

• Coordinate with local or regional CoCs and other homeless service efforts within the county.

• Include people with lived experience of homelessness and serious behavioral health conditions —both SMI and SUD—as part of BHBH programmatic planning, implementation, and quality improvement.

• Submit policies and procedures for Participant Assistance Funds, Rental Assistance, and/or Landlord Outreach and Mitigation Funds, as applicable.

• Certain uses of bridge housing startup infrastructure funding will also require documentation of site control; insurance; compliance with federal, state, and local laws; and other certifications, as applicable.

• Submit and update a BHBH Program Plan, using a template to be provided, that describes how the county BHA will use the BHBH Program funds.

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Bridge Housing Eligible Uses and Requirements

• At least 75 percent of the BHBH Program funds must be used for the costs of operating bridge housing that serves people with serious behavioral health conditions who are also experiencing homelessness, using best practices in the delivery of bridge housing. Bridge housing settings may be leased or owned by the county or by contracted provider partners.

• Bridge housing will be established and provided based on community needs and Housing First principles and will include voluntary supportive services for individuals experiencing both homelessness and serious behavioral health conditions; the county BHA will outline these services in the required BHBH Program Plan. Consistent with the national Housing First model and WIC section 8255, abstinence from alcohol or other substances cannot be a requirement or prerequisite for housing funded by the BHBH Program; the use of alcohol or other substances in and of itself cannot be grounds for eviction; services are informed by a harm-reduction philosophy that recognizes drug and alcohol use and substance use disorder as a part of tenants’ lives, where tenants are engaged in nonjudgmental communication regarding drug and alcohol use; and where tenants are offered education regarding how to avoid risky behaviors and engage in safer practices, as well as connected to evidence-based treatment if the individual so chooses. However, when indicated, funding may be used to support recovery residences and sober living environments for individuals with significant substance use disorder needs.

• Bridge housing must meet the Emergency Solutions Grants (ESG) habitability standards and, when possible and as applicable, should also meet CoC Housing Quality Standards (HQS).

• Support access to medication assisted treatment (MAT) and psychotropic medications for the treatment of mental disorders.

• Prioritize and ensure that eligible CARE Program participants receive BHBH Program services.

• County BHAs may implement outreach and progressive engagement strategies to offer and encourage individuals and/or families to enter the BHBH Program. These services may be carried out by staff of a BHBH site or by an outreach team.

• Housing navigation and other supports will be made available to assist BHBH Program participants in accessing sustainable, affordable, permanent housing resources. Such supportive services and supports should be coordinated with existing systems of care.

• Develop programs in a manner that allows for choice, enables people to stay in their “home” communities to the extent possible, and provides for community integration in accordance with all applicable federal and state regulations.

• County BHAs must maximize all other funding sources, including Medi-Cal, to the greatest extent possible and should add new bridge housing beds to the system of care. BHBH Program funds may not be used to pay for existing services or housing supports that are currently reimbursed, or eligible for reimbursement through Medi-Cal (including Enhanced Care Management, Targeted Care Management, and Community Support Services), funding sources such as Mental Health Services Act-funded programs, or other federal or local programs.

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Bridge Housing Start-up and Infrastructure Requirements

• Complete all bridge housing start-up infrastructure activities and make beds available within 1 year of contract execution. Grantees that make beds available within 90 and 180 days will receive a competitive advantage in future rounds of BHBH Program funding, based on the number of beds made available within these time frames.

• If providing rental assistance, submit for DHCS review related policies and procedures that address the following:

• The calculation of rental assistance.

• Clear eligibility requirements for individuals and units for short-term and/or mid-term rental assistance.

• Fraud prevention.

• Requirements for payments to be made directly to property owners or managers.

• Requirements to provide supportive services to individuals receiving rental assistance, including assistance to remove barriers and help them obtain longer-term rental assistance or other affordable housing.

• Requirements for participants to have access to onsite supportive services at the housing site or through a home visit component.

Reporting, Monitoring, and Communication Requirements

• Enter data on the individuals and families served by the BHBH Program into the local Homeless Management Information System (HMIS), as required by AB 977 (Gabriel, Chapter 397, Statutes of 2021).

• Submit quarterly narrative and data reports that document progress toward improved outcomes as described in the proposal and BHBH Program Plan.

• Participate in monthly calls, learning collaboratives, and other TTA activities.

• Meet the funding requirements for BHBH Program elements as identified in the BHBH Program Plan, conduct financial review auditing and fraud prevention, and ensure appropriate uses of funds.

• Provide required program updates and participate in monitoring and reimbursement reviews with DHCS and/or AHP, as requested.

ALLOWABLE USES OF FUNDS

BHBH Program funds will be used for bridge housing to build collaboration, increase resources, and fill gaps by addressing the housing needs of individuals experiencing both homelessness and a serious behavioral health condition (SMI or SUD, or both).

The selection of the best methods for delivering bridge housing will depend on the unique needs and resources of each county, but all county BHAs must meet the program requirements as outlined in Attachment C. DHCS has identified four general program categories for BHBH Program funding:

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• County BHA BHBH Program Implementation

• Bridge Housing Outreach and Engagement

• Bridge Housing

• Shelter/interim housing

• Rental assistance

• Auxiliary funding in assisted living settings

• Housing navigation

• Bridge Housing Start-Up Infrastructure

More detailed information about the types of housing, activities, and costs BHBH Program funds can support in each of these categories is included in Attachment C. In its application, each county BHA must indicate the type(s) of program(s) it intends to develop or expand with BHBH Program funding and provide details on how the program(s) will be implemented.

County BHAs are encouraged to explore innovative models using existing real estate that can be leased or quickly converted to create new BHBH Program settings, including, but not limited to, the following:

• Tiny homes

• Master-leased units or buildings

• Office, school, or warehouse conversions (Warehouse conversion should be designed to support privacy, as dormitory-style housing is not recommended for the BHBH Program.)

• Hotels and motels

• Churches and other community settings

• Duplexes or large single-family homes

• Modular buildings

• Decommissioned skilled nursing facilities (SNFs), assisted living, hospital conversions, etc.

• Scattered-site individual units

The BHBH Program supports bridge housing settings including necessary housing operation costs (e.g., facility rent, utilities, Wi-Fi, insurance, onsite staffing, repairs, food, hygiene products), as well as the costs for additional services to support participants’ housing stability and retention and wellness.

These funds may not be used to supplant existing federal, state, or county funds used to provide housing or services, including through Medi-Cal (including Enhanced Care Management, Targeted Case Management, and Community Supports), programs funded under the Mental Health Services Act (MHSA), federally funded programs, or other state or local programs.

Applicants may propose using BHBH Program funds to complement or enhance federal, state, or local funds and programs; if they choose to do so, they must describe how the BHBH Program-funded activities would complement or enhance similar or related services and activities. BHBH Program funding may be used to support complementary activities or enhanced investments of existing work if, emjar Highlight emjar Highlight for example, existing funds (1) do not fully reimburse activities or (2) support additional or different services beyond those that would be funded under the BHBH Program. BHBH Program funds may not duplicate reimbursement for activities funded by other federal, state, or local programs.

If BHBH Program funds are used for Participant Assistance Funds, Rental Assistance, or Landlord Outreach and Mitigation Funds, county BHAs must provide their policies and procedures for review prior to receipt of the funds. Policies and procedures will include prevention of fraud, waste, and abuse and the documentation they will require for the use of Participant Assistance Funds, Rental Assistance, or Landlord Outreach and Mitigation Funds. See Attachment C for additional requirements on bridge housing start-up infrastructure funds. County BHAs may claim up to 10 percent of modified direct costs for indirect costs. See Attachment E for other allowable direct operating expenses.

APPLICATION PROCESS

The application and attachments, along with instructions for submitting the completed application, can be found on SurveyMonkey Apply. Applications will be accepted electronically beginning on February 24, 2023. Applications may not be hand delivered or mailed. The deadline for all applications is April 28, 2023, at 4:00 p.m. PT. DHCS will not accept any funding applications after the due date.

Information provided by the applicant can be made available for public review, unless otherwise exempted by law (Inspection of Public Records, Chapter 3.5, Division 7, Government Code).

PROJECT TIMELINE

Table 2. Project Timeline*

Event Date County BHAs RFA released February 22, 2023 Informational webinar March 3, 2023, 10:00 a.m. PT County BHAs applications due† Accepted on a rolling basis on or before April

28, 2023, 4:00 p.m. PT County BHA conditional awards announced On a rolling basis, beginning June 2023 Contracts executed Within 60 days of county BHA’s receipt of initial contract *Timeline subject to change at DHCS’s discretion.

†DHCS will not accept any funding applications after the due date. Funding not applied for will be included in the competitive RFA process in summer 2023.

APPLICATION INSTRUCTIONS

The BHBH Program is designed to allow county BHAs to implement the most appropriate strategies for their communities while adhering to responsive best practices and using funds appropriately, as intended by law, and within the parameters of DHCS guidance. Program proposals must include baseline data and a description of the rationale for selecting the chosen intervention(s).

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The BHBH Program application uses a fillable form on an online application portal hosted by SurveyMonkey Apply. Before beginning the application, please review the application questions in Attachment D. To complete the required budget, please follow the budget instructions in Attachment E. Use the Excel template available on the Behavioral Health Bridge Housing Program RFA page and upload the budget and budget narrative to the application portal.

You will be able to upload additional required documents, including an organizational chart, a budget, a budget narrative, and any other supporting documentation, to SurveyMonkey Apply. You will receive an email confirming receipt of the complete application within 24 hours of submission.

INFORMATIONAL WEBINAR

An informational webinar on March 3, 2023, at 10:00 a.m. PT will provide information about both the BHBH Program and the county BHA application. Registration is required. The webinar will be recorded and posted on the BHBH Program website.

QUESTIONS

To submit a question related to the RFA or the application instructions, or to submit a technical question related to the online application portal, please use the RFA Help Desk.

REASONABLE ACCOMMODATIONS

DHCS will provide assistive services such as reading or writing assistance and conversion of the RFA, questions and answers, RFA addenda, or other Administrative Notices to Braille, large print, audiocassette, or computer disk as needed. To request copies of written materials in an alternate format, please send an email to BHBHinfo@ahpnet.com or call (323) 545-6202.

PROPOSAL REVIEW CRITERIA

County BHAs must respond to all questions, address the minimum program requirements, and describe their proposed plan and budget in detail. Each section of the application will be reviewed as either “sufficient,” or “resubmission required.” County BHAs whose applications are found to need resubmission will be contacted to schedule a consultation with AHP and will have up to 30 days from the time of notification to meet any resubmission requirements to remain eligible for BHBH Program funds.

It is DHCS’s intent to work with all applicants to establish fundable applications. Failure to submit the required documentation in a manner DHCS deems appropriate by the date and time indicated in follow-up communications with the county BHA may lead DHCS to find the applicant nonresponsive and eliminate the application from further BHBH Program funding consideration. In addition, DHCS may provide a partial award to a county BHA if components of its application are deemed unallowable or the applicant does not provide sufficient follow-up information.

AWARD PROCESS

Successful applicants will be notified by email of a conditional award, of any resubmission requirements, or that funding has been denied. AHP will schedule meetings with conditional awardees to discuss the https://buildingcaldata.smapply.us/prog/bhbh_county_behavioral_health_agencies_request_for_applications_rfa/ https://bridgehousing.buildingcalhhs.com/county-behavioral-health-agencies/ https://us06web.zoom.us/webinar/register/WN_t8PNjSKwSCSYQj8YA4rkjQ https://bridgehousing.buildingcalhhs.com/ https://app.smartsheet.com/b/form/799e187a0295438d85a6616ca9e58bfa mailto:BHBHinfo@ahpnet.com https://bridgehousing.buildingcalhhs.com/county-behavioral-health-agencies/ emjar Highlight emjar Highlight emjar Highlight emjar Highlight contracting process, including development of the statement of work (SOW) and payment schedule. A draft sample contract will be made available during the application period. All applicants must be able to process a contract for final execution/approval within 60 days of receipt of initial contract. The final agreement must be signed, returned, and fully executed with AHP before funding will be made available.

APPEALS

Applicants submitting a response to this RFA may not protest or appeal the award. All award decisions are final.

STATE’S RIGHTS

1. If deemed necessary by DHCS, DHCS, directly or through AHP, may collect additional applicant documentation, signatures, missing items, or omitted information during the application review process. DHCS will advise the applicant by email or in writing of any documentation that is required and the submission timeline. Failure to submit the required documentation in a manner DHCS deems responsive by the date and time indicated may lead DHCS to find the applicant nonresponsive and eliminate the application from further BHBH Program funding consideration.

2. The submission of a response to this RFA does not obligate DHCS to make a contract award.

3. DHCS reserves the right to deem incomplete responses as nonresponsive to the RFA requirements.

4. DHCS reserves the right to modify or cancel the RFA process at any time.

5. Any of the following may cause DHCS to reject a response from further consideration:

a. Failure to meet the state applicant requirements by the submission deadline.

b. Failure to comply with a request to submit additional documentation in a timely manner.

c. Failure to comply with all performance requirements, terms, conditions, and/or exhibits that are being prepared for the resulting contract.

V. Administrative Requirements

ANNUAL REVIEW AND PROGRAM MODIFICATIONS

BHBH Program funding must be spent no later than June 30, 2027. County BHA funding will be monitored and paid through reimbursement invoicing, based on the achievement of identified milestones provided through required reporting, as outlined below. Changes to the BHBH Program Plan, including the timeline, and budget modifications will be accepted only by written request and must be approved by DHCS. County BHA progress will be reviewed annually. If a county BHA is not on track to meet funding deliverables and spend its full contracted amount, DHCS reserves the right to redistribute those grant funds to other eligible county BHAs.

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REPORTING REQUIREMENTS

Grantees will be required to submit quarterly progress reports that include narrative and data reports.

Grantees will also submit invoices of actual expenditures based on the deliverables outlined in the contract. Invoices will not be paid until all required data have been submitted.

Grantees will submit data reports in a data portal. The metrics will include, but not be limited to, the following:

• Number of people served and demographic information

• CARE Program participants receiving BHBH supportive services

• Bed-nights of bridge housing provided in each of the following:

• Shelter/interim housing

• Rental assistance (scattered site and project based)

• Auxiliary funding in assisted living settings (commonly referred to as “board and care patches”)

• Outcomes

• Shelter/interim housing

a. Numbers of individuals served

b. Location upon exit

c. Average length of stay

d. Total number of bed-nights of bridge housing provided during the quarter (occupied bed-nights)

e. Total number of available bed-nights that were left vacant

• Rental assistance

a. Number of individuals who were provided rental assistance (scattered site or project based)

b. Location upon exit

c. 6-, 12-, and 24-month housing stability measures

• Auxiliary services in assisted living settings (commonly referred to as “board and care patches”)

a. Number of individuals served

b. Location upon exit

c. 6-, 12-, and 24-month housing stability measures

Additionally, grantees will enter into the local HMIS the Universal Data Elements (Items 3.01-3.917) and the Common Data Elements (Items 4.02-4.20 and Item W5 of the Individual Federal Partner Program Elements as defined by the United States Department of Housing and Urban Development [HUD] HMIS Data Standards), on the individuals and families served, as required by AB 977 (Gabriel, Chapter 397, Statutes of 2021).

Quarterly progress reports will follow the timeline below.

Table 3. Quarterly Progress Report Schedule

Report Year/Quarter Period Date Due 1 Year 1, Quarter 4 4/1/-6/30/2023 7/30/2023 https://www.hudexchange.info/programs/hmis/hmis-data-standards/standards/#t=Introduction.htm https://www.hudexchange.info/programs/hmis/hmis-data-standards/standards/#t=Introduction.htm

Report Year/Quarter Period Date Due 2 Year 2, Quarter 1 7/1-9/30/2023 10/30/2023 3 Year 2, Quarter 2 10/1-12/31/2023 1/30/2024 4 Year 2, Quarter 3 1/1-3/31/2024 4/30/2024 5 Year 2, Quarter 4 4/1-6/30/2024 7/30/2024 6 Year 3, Quarter 1 7/1-9/30/2024 10/30/2024 7 Year 3, Quarter 2 10/1-12/31/2024 1/30/2025 8 Year 3, Quarter 3 1/1-3/31/2025 4/30/2025 9 Year 3, Quarter 4 4/1-6/30/2025 7/30/2025 10 Year 4, Quarter 1 7/1-9/30/2025 10/30/2025 11 Year 4, Quarter 2 10/1-12/31/2025 1/30/2026 12 Year 4, Quarter 3 1/1-3/31/2026 4/30/2026 13 Year 4, Quarter 4 4/1-6/30/2026 7/30/2026 14 Year 5, Quarter 1 7/1-9/30/2026 10/30/2026 15 Year 5, Quarter 2 10/1-12/31/2026 1/30/2027 16 Year 5, Quarter 3 1/1-3/31/2027 4/30/2027 17 Year 5, Quarter 4 4/1-6/30/2027 6/30/2027

PARTICIPATION IN MONITORING AND TTA

Grantees will be responsible for submitting invoices, ensuring expenses are allowable, and retaining sufficient backup documentation related to expenses. DHCS, AHP, or a designee may conduct desk or site audits that require grantee participation.

Grantees will be required to submit documentation for specific projects prior to the drawdown of funds.

This includes but is not limited to the following:

• Participant Assistance Funds, Rental Assistance, and Landlord Outreach and Mitigation Fund policies and procedures, as applicable.

• For use of bridge housing start-up infrastructure funds for certain costs, including rehabilitation, the purchase of tiny homes, or the purchase of property, the following may be required:

documentation of site control; insurance; compliance with federal, state, and local laws; and other certifications and requirements, as applicable. (See Attachment C.)

Grantees will also be expected to participate in coaching calls, learning collaboratives, and other required TTA activities.

Technical assistance topics will focus on data tracking and reporting including hands-on support in integration with the HMIS system. Reporting beds and rental subsidies in the HMIS system is a program requirement and technical assistance will provide guidance associated with system design elements for HMIS as it pertains to the BHBH Program funding requirements (see Reporting, Monitoring, and Communication Requirements section for more details). Technical assistance will also focus on bridge housing site locations, including the identification of appropriate sites that could be converted into bridge housing. Various toolkits will be provided, including optional templates for grantee use such as operations manuals, start-up checklists, and rental assistance administration guides.

ACCESSIBILITY AND NONDISCRIMINATION

All BHBH Program-funded projects shall adhere to the accessibility requirements set forth in California Building Code Chapters 11A and 11B and the Americans with Disabilities Act (ADA), Title II. In addition, developments shall adhere to either the Uniform Federal Accessibility Standards (UFAS, 24 CFR Part 8) or HUD’s modified version of the 2010 ADA Standards for Accessible Design (Alternative 2010 ADAS, HUD-2014-0042-0001, 79 FR 29671 [5/27/14], commonly referred to as “the Alternative Standards” or “HUD Deeming Memo”). Accessible units shall, to the maximum extent feasible and subject to reasonable health and safety requirements, be distributed throughout the project and be available in a sufficient range of sizes and amenities consistent with 24 CFR Part 8.26.

Grantees shall adopt a written nondiscrimination policy requiring that no person shall, on the grounds of race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital status, national origin, ancestry, familial status, source of income, disability, age, medical condition, genetic information, citizenship, primary language, immigration status (except where explicitly prohibited by federal law), justice system involvement (except where explicitly required by law), or arbitrary characteristics, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any project or activity funded in whole or in part with funds made available pursuant to this RFA. Nor shall all other classes of individuals protected from discrimination under federal or state fair housing laws, individuals perceived to be a member of any of the preceding classes, or any individual or person associated with any of the preceding classes be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any project or activity funded in whole or in part with funds made available pursuant to this RFA.

Grantees shall comply with the requirements of the Americans with Disabilities Act of 1990, the Fair Housing Amendments Act, the California Fair Employment and Housing Act, the Unruh Civil Rights Act, Government Code Section 11135, Section 504 of the Rehabilitation Act of 1973, and all regulations promulgated pursuant to those statutes, including 24 CFR Part 100, 24 CFR Part 8, and 28 CFR Part 35.

Attachment A: Maximum County Funding

Counties with separate departments of mental health and substance use services may submit separate applications, but the total amount of funding requested may not exceed the total amount available for the county, as listed. The formula used to calculate these figures is based on a $1,000,000 minimum base per county and the current Behavioral Health Subaccount (50 percent), and Point-in-Time (50 percent) funding methodologies.

County Total Funding Available

County Total Funding Available

Alameda $46,782,359 Orange $31,658,038 Alpine $1,067,142 Placer $4,364,704 Amador $1,741,012 Plumas $1,648,932 Butte $7,510,000 Riverside $24,004,293 Calaveras $1,728,261 Sacramento $43,077,410 Colusa $1,502,677 San Benito $2,260,924 Contra Costa $20,488,722 San Bernardino $27,375,170 Del Norte $2,618,164 San Diego $44,300,211 El Dorado $3,339,411 San Francisco $32,265,440 Fresno $21,833,333 San Joaquin $14,303,642 Glenn $1,746,530 San Luis Obispo $7,519,236 Humboldt $7,117,861 San Mateo $10,246,862 Imperial $6,968,054 Santa Barbara $9,932,242 Inyo $1,488,504 Santa Clara $51,568,399 Kern $15,159,004 Santa Cruz $10,171,130 Kings $2,919,309 Shasta $5,268,887 Lake $2,820,089 Sierra $1,090,326 Lassen $1,637,126 Siskiyou $2,425,534 Los Angeles $321,189,238 Solano $8,352,207 Madera $2,996,547 Sonoma $11,246,961 Marin $5,467,915 Stanislaus $10,819,200 Mariposa $1,396,991 Sutter $3,805,915 Mendocino $4,937,108 Tehama $2,371,591 Merced $6,915,610 Trinity $1,756,528 Modoc $1,260,647 Tulare $11,047,883 Mono $1,229,946 Tuolumne $2,077,802 Monterey $11,301,966 Ventura $13,325,088 Napa $3,425,528 Yolo $4,132,715 Nevada $3,601,814 Yuba $3,327,862

TOTAL $907,936,000

Attachment B: Definitions

Bridge Housing For purposes of the BHBH Program, “bridge housing” is defined as short- and mid-term residential programs with a goal to connect individuals to long-term housing stability. The BHBH Program uses a broad definition of “bridge housing” that may include, and may not be limited to, emergency/interim housing, rental assistance, and auxiliary funding in assisted living settings (commonly referred to as “board and care patches”). See Attachment C for more details on bridge housing types. BHBH settings must offer supportive services that address the housing needs of participants. BHBH Programs are low barrier and use harm reduction strategies and Housing First principles. However, when indicated, funding may be used to support recovery residences and sober living environments for individuals with significant substance use disorder needs. Bridge housing must meet the ESG Minimum Habitability Standards and, when possible and as applicable, should also meet CoC Housing Quality Standards (HQS).

Family “Family” includes, but is not limited to, regardless of marital status, actual or perceived sexual orientation, or gender identity, any group of persons presenting for assistance together with or without children and irrespective of age, relationship, or whether or not a member of the household has a disability. A child who is temporarily away from the home because of placement in foster care is considered a member of the family. (Source: HUD Continuum of Care Program FAQ)

Housing First Housing First is defined in WIC Section 8255 (11)(d)(1)-(2)(A) as “the evidence-based model that uses housing as a tool, rather than a reward, for recovery and that centers on providing or connecting homeless people to permanent housing as quickly as possible. Housing First providers offer services as needed and requested on a voluntary basis and do not make housing contingent on participation in services. Housing First includes time-limited rental or services assistance, so long as the housing and service provider assists the recipient in accessing permanent housing and in securing longer-term rental assistance, income assistance, or employment.”

Consistent with the national Housing First model and WIC section 8255, abstinence from alcohol or other substances cannot be a requirement or prerequisite for housing funded by the BHBH Program, nor can the use of alcohol or other substances in and of itself be grounds for eviction; services are informed by a harm-reduction philosophy that recognizes drug and alcohol use and addiction as a part of tenants’ lives, where tenants are engaged in nonjudgmental communication regarding drug and alcohol use, and tenants are offered education regarding how to avoid risky behaviors and engage in safer practices, as well as connected to optional evidence-based treatment. However, when indicated, funding may be used to support recovery residences and sober living environments for individuals with significant substance use disorder needs.

Housing Navigation Housing navigation is an integral part of the process of assisting people in identifying housing options, resources, and services. Housing navigators work with individuals to help them find, move in to, and retain affordable housing. They also develop relationships with community partners, other service providers, agencies offering housing subsidies, and property owners and managers. Navigators help individuals eliminate or reduce the impact of personal housing barriers such as criminal records, poor https://dhhs.ne.gov/NHAP%20Documents/ESG-Emergency-Shelter-and-Permanent-Housing-Standards.pdf https://dhhs.ne.gov/NHAP%20Documents/ESG-Emergency-Shelter-and-Permanent-Housing-Standards.pdf https://www.hudexchange.info/homelessness-assistance/coc-esg-virtual-binders/coc-leasing-rental-assistance-requirements/codes-and-standards/ https://www.hudexchange.info/faqs/programs/emergency-solutions-grants-esg-program/program-requirements/eligible-participants/how-is-the-definition-of-family-that-was-included/ credit, or prior housing judgments due to eviction, as well as transportation needs, application fees, and/or utility payments. Additionally, housing navigators may assist in identification and reporting of instances of housing discrimination. They may link individuals with bridge housing and housing subsidy agencies and assist them in completing application. They may also work with property owners and public housing authorities (PHAs) to facilitate approvals, assisting with documentation, timely inspections, and corrective action requests.

Serious Behavioral Health Condition The BHBH Program eligibility criteria are adapted from the Specialty Mental Health Services (SMHS) access criteria (BHIN 21-073) and the Drug Medi-Cal Organized Delivery System/Drug Medi-Cal access criteria ( BHIN 21-071; BHIN 23-001), including all CARE Program participants. There are no age restrictions on BHBH Program participants. To be eligible for a BHBH Program-funded project, an individual must meet one of the following criteria:

1. The individual has one or more of the following:

a. Significant impairment, where “impairment” is defined as distress, disability, or dysfunction in social, occupational, or other important activities, including education and family relationships

b. A reasonable probability of significant deterioration in an important area of life functioning

c. A need for SMHS, regardless of presence of impairment (for individuals under age 21)

AND

The individual’s condition, as defined in a, b, and/or c, is due to either of the following:

a. A diagnosed mental and/or substance-related or addictive disorder, according to the criteria of the current editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Statistical Classification of Diseases and Related Health Problems (ICD)

b. A suspected mental and/or substance-related or addictive disorder that has not yet been diagnosed

OR

2. The individual has at least one of the following:

a. At least one diagnosis from the current edition of the DSM for Substance-Related and

Addictive Disorders, with the exception of Tobacco-Related Disorders and Non- Substance-Related Disorders

b. At least one suspected diagnosis from the current edition of the DSM for Substance- Related and Addictive Disorders, with the exception of Tobacco-Related Disorders and Non-Substance-Related Disorders

OR

3. The individual is a CARE Program participant, regardless of whether they meet the criteria in paragraph (1) or (2), above.

https://www.dhcs.ca.gov/Documents/BHIN-21-073-Criteria-for-Beneficiary-to-Specialty-MHS-Medical-Necessity-and-Other-Coverage-Req.pdf https://www.dhcs.ca.gov/Documents/BHIN-21-071-Medical-Necessity-Determination-Level-of-Care-Determination-Requirements.pdf https://www.dhcs.ca.gov/Documents/BHIN-23-001-DMC-ODS-Requirements-for-the-Period-of-2022-2026.pdf emjar Highlight emjar Highlight emjar Highlight emjar Highlight emjar Highlight emjar Highlight emjar Highlight emjar Highlight

Short-Term and Mid-Term For purposes of the BHBH Program, “short-term” is defined as less than 90 days and “mid-term” is a period between 90 days and 2 years, with the possibility of a 1-year extension. Because the BHBH Program sunsets on June 30, 2027, its funds cannot be used to support longer-term housing or rental assistance. County BHAs are encouraged to allow flexible lengths of stay in bridge housing settings to ensure housing navigation and placement services can take place and that individuals are exited to permanent housing to the greatest extent possible.

Supportive Services Supportive services are those services necessary to help program participants obtain and maintain housing, manage symptoms of serious behavioral health conditions, and support recovery and wellness.

Examples include peer support, employment assistance, transportation assistance, and group and individual activities that promote a sense of purpose and community participation. Services covered by Medi-Cal cannot be paid for with BHBH Program funding. BHBH funds cannot be used as a match for Medi-Cal services. Counties must leverage Medi-Cal to the greatest extent possible, through use of California Advancing and Innovating Medi-Cal (CalAIM) programs including Enhanced Care Management, as well as the housing-related community supports.

Homeless For purposes of the BHBH Program, the definition of “homeless” is based on the definition used in the Enhanced Care Management program (ECM Policy Guide, May 2022, page 8), as outlined below.

An individual or family experiencing homelessness is defined as any of the following:

• An individual or family that lacks adequate nighttime residence

• An individual or family with a primary residence that is a public or private place not designed for or ordinarily used for habitation

• An individual or family living in a shelter

• An individual exiting an institution (including incarceration) into homelessness

• An individual or family who will imminently lose housing in next 30 days

• Unaccompanied youth and homeless families and children and youth defined as homeless under other federal statutes

• Individuals fleeing intimate partner violence

Notes on this definition:

This definition is based on the HUD definition of “homeless,” with the following modifications:

• If exiting an institution, individuals are considered homeless if they were experiencing homelessness immediately prior to entering that institutional stay, regardless of the length of the institutionalization.

• The time frame for an individual or family that will imminently lose housing has been extended from 14 days (HUD definition) to 30 days.

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Attachment C: Allowable BHBH Program Activities

The goal of the BHBH Program is to expand the available bridge housing to support individuals with serious behavioral health conditions. Therefore, the funding is prioritized on the bridge housing category. All other category expenditures are allowable up to the percentage identified below.

The following describes activities that are allowable uses of BHBH Program funds for meeting the program requirements as discussed in Section IV. This list is not intended to be comprehensive. Any additions to this list must be preapproved by DHCS.

BRIDGE HOUSING (MINIMUM OF 75 PERCENT OF TOTAL BUDGET)

For purposes of the BHBH Program, “bridge housing” is defined as short- and mid-term residential options and serves as a bridge to longer-term housing (see Attachment B). Bridge housing must meet the ESG Minimum Habitability Standards and, when possible and as applicable, should also meet CoC Housing Quality Standards (HQS). All bridge housing settings must include voluntary supportive services for individuals.

County BHAs and their partners may provide bridge housing through any of several methods, including directly operating or contracting for shelter/interim housing beds, providing short- or mid-term rental assistance, or for auxiliary funding in assisted living settings (commonly referred to as “board and care patches”). Counties may work with homelessness service providers to expand capacity and/or provide necessary supports and accommodations so individuals with serious behavioral health conditions can succeed in programs originally designed for the broader population experiencing homelessness. BHBH programs must be developed in a manner that provides for choice, enables people to stay in their “home” communities, and provides for community integration in accordance with all applicable federal and state regulations.

When not covered by another funding source (due to the restrictions of non-supplantation), allowable costs for BHBH settings include necessary housing operation costs (e.g., facility rent, utilities, Wi-Fi, insurance, onsite manager, repairs, food, hygiene products), as well as the costs for supportive services to support participants’ housing stability and retention. Funds may be used to support the development of partnerships and create a model to administer rental subsidies. Expenditures related to pet accommodations are allowable.

BHBH models or housing types should be selected based on community needs and gaps and may include shelter/interim housing, rental assistance coupled with supportive services, and/or auxiliary funding in assisted living settings (commonly referred to as “board and care patches”), and all must include housing navigation for individual sustainability.

BHBH is provided through the three housing types described below and includes housing navigation.

Shelter/Interim Housing. Shelter or interim housing is intended to be of short- or mid-term duration while individuals are preparing to move into longer-term housing options such as Permanent Supportive Housing (PSH) or other stable living situations. For purposes of the BHBH Program, this could include tiny homes, emergency shelter, motel vouchers or motel-based sheltering efforts, navigation centers, https://dhhs.ne.gov/NHAP%20Documents/ESG-Emergency-Shelter-and-Permanent-Housing-Standards.pdf https://www.hudexchange.info/homelessness-assistance/coc-esg-virtual-binders/coc-leasing-rental-assistance-requirements/codes-and-standards/ https://www.hudexchange.info/homelessness-assistance/coc-esg-virtual-binders/coc-leasing-rental-assistance-requirements/codes-and-standards/ emjar Highlight emjar Highlight emjar Highlight emjar Highlight emjar Highlight peer respite, crisis housing, transitional housing, recovery housing, recuperative care models, and/or community-reentry and diversion housing programs.

Bridge housing may include individual units, shared living (with private or smaller-occupancy rooms), individual rooms in homes, or tiny homes. Congregate environments (e.g., dorms with larger-occupancy rooms) may be considered, but only if they can be proven appropriate for the population.

Rental Assistance. County BHAs may also offer short- or mid-term rental assistance or subsidies as part of an overall bridge housing strategy. Rental assistance must be combined with easy access to clinical and supportive behavioral health care. Rental payments must be made to the landlord on behalf of the tenant in scattered-site or project-based housing. The duration of rental assistance is at the discretion of the county BHA but should take into consideration the funding end date.