Introduction
Older adults often have significant behavioral health needs but accessing care is challenging. The Behavioral Health Services Act (BHSA) offers the state of California an opportunity to address the behavioral health needs of older adults in a manner that reduces barriers to care and prioritizes the highest-need populations among those eligible.
As the state and counties prepare to determine how new BHSA funds will be spent, older adult advocates have an opportunity to help shape a system that will support older adults as they age. This fact sheet explains why behavioral health matters for older adults, provides background on the development and scope of the BHSA, and highlights upcoming advocacy opportunities for older adult advocates.
Why are Behavioral Health Services Important for Older Adults?
Behavioral health services are integral in supporting older adults to age with dignity. Older adults face significant behavioral health needs, and existing data show these needs often go unmet. California’s Department of Aging conducted a survey of older adults in 2023, which found that 40% of respondents felt lonely or isolated, and 45% reported feeling depressed.[1] This data is consistent with national data that show that social isolation is highest among older adults.[2]
The risk of suicide also increases with age, and is highest for those 85 and older.[3] In 2019, 21% of all suicide deaths in California occurred among individuals age 65 and older.[4] At the same time, drug overdoses and deaths among older adults have tripled in the last 20 years.[5] Older adults also experience high rates of cognitive decline and dementia that can compound their behavioral health needs and also impact the behavioral health of their caregivers.[6]
Further, experiences of racism and discrimination prevent older adults from seeking care, “more than a quarter of U.S. older adults said they did not get the care or treatment they felt they needed because of discrimination.”,[7] Over one-quarter of LGBTQ+ older adults in California report being treated unfairly or discriminated against in the past year.[8]
Rising rates of older adult homelessness further complicate behavioral health treatment. Older adults are the fastest growing cohort experiencing homelessness, with a majority experiencing homeless for the first time in their life in old age.[9] Mirroring the demographics of the greater homeless population, Black older adults are overrepresented.
[10] These data are a representation of the cumulative impacts of discriminatory social services and housing policies and highlight the need for a culturally-competent approach.
Many older adults also have trouble accessing behavioral health services because coverage is fragmented and complex. Medicare is the primary insurer for most older adults, but it has significant gaps in behavioral health coverage. For older adults with limited resources who are dually eligible for Medicare and Medi-Cal, Medi-Cal helps fill many of those gaps – offering more comprehensive benefits and covering Medicare out-of-pocket costs like co-pays and co-insurance.
However, Medi-Cal behavioral health services are split between county mental health plans and Medi-Cal managed care plans. The difficultly navigating Medicare coverage and the two Medi-Cal delivery systems reduces the likelihood that older adults get the care they need. At the same time, there is a lack of behavioral health services targeted to older adults.[11]
These challenges make clear that older adult advocates have an important role in guiding behavioral health systems to better serve the unique needs of older adults.
Behavioral Health Services Act (BHSA) History and Scope
In March of 2024, voters approved Proposition 1, which consisted of two legislative bills: the Behavioral Health Services Act (SB 326) and the Behavioral Health Infrastructure Bond Act (AB 531).[12] These two bills replace the Mental Health Services Act (MHSA) of 2004. The Behavioral Health Services Act (BHSA) modernizes the state’s approach to mental health services by expanding eligibility and the range of available services and supports.
The state aims to use BHSA to “improve access to care, increase accountability and transparency … and expand the capacity of behavioral health care facilities across California.” [13] In addition, the Behavioral Health Infrastructure Bond Act provides $6.38 million for new behavioral health treatments beds and supportive housing units. Uniting housing with behavioral health services establishes a new approach to serving community members with the greatest needs.
There are several major changes in the transition from the previous Mental Health Services Act (MHSA) to BHSA:
Eligibility Expansion
All older adults who meet BHSA eligibility requirements are eligible for behavioral health services.[14] BHSA does not specify an age range for “older adults” and there is no requirement to be enrolled in Medi-Cal.[15] BHSA also expands eligibility for services to include “treatment for substance use disorder, regardless of the presence of a co-occurring mental health condition.”[16]
Priority Populations
In addition to the basic BHSA eligibility requirements, BHSA requires counties to prioritize several sub-groups of adults and older adults with “the highest need and at greatest risk for negative outcomes along the care continuum.” [17] These include older adults at risk or experiencing homelessness, at risk of conservatorship, and at risk for institutionalization.[18]
Population-Based Prevention
BHSA carves out dedicated funding to the California Department of Public Health (CDPH) for behavioral health prevention services. CDPH population prevention services include public awareness efforts and coordination of statewide suicide prevention efforts. [19]
Funding Structure
BHSA reallocates behavioral health funding to counties. County funding is divided into the following allocations: 35% for Behavioral Health services and supports (BHSS)[20], 35% for Full-Service Partnerships (FSP)[21], and 30% for Housing interventions. Of the 30% for Housing Interventions, 50% must be used for people who are chronically homeless, with a focus on those in encampments.[22]
Culturally-Competent Approaches
BHSA requires the Department of Health Care Services (DHCS) to establish standards for BHSA services. These standards require service planning to “consider cultural, linguistic, gender, age and special needs of target populations.” Further, service provision must be made for a “workforce with the cultural background and linguistic skills necessary to remove barriers” to access.[23]
Advocacy Opportunities
Integrated Plans
BHSA requires each county to submit a 3-year Integrated Plan (IP) for Behavioral Health Services and Outcomes to the Department of Health Care Services (DHCS). Unlike MHSA plans, BHSA uses the IP as a “prospective global spending plan” demonstrating how counties intend to use all available behavioral health funding, not just BHSA funding, to address unmet need and reduce disparities. [24] IPs must be data-backed. [25] Drafts of IP’s are due to DHCS March 31, 2026. A final IP will be due no later than June 30, 2026. Counties are required to update their IP annually on the same schedule.[26]
As a part of the IP drafting process, counties are required to conduct “meaningful stakeholder involvement” with constituents and stakeholders. DHCS requires engagement with various groups including (but not limited to): eligible older adults, individuals with lived experience, Area Agencies on Aging, independent living centers, continuums of care, and community-based organizations serving culturally and linguistically diverse constituents. [27]
It is essential for older adult advocates to uplift the needs of older adults by participating in their county’s IP stakeholder engagement process. Of importance, advocates should highlight where age-based behavioral health disparities exist in their community. Older adults’ increased risk of isolation, abuse and exploitation, and institutionalization are unique factors that can impact their ability to access behavioral health services.
Advocates can also uplift the lived experience of older adults currently navigating behavioral health systems. The unique positions of older adults must be highlighted in IPs to avoid creating additional barriers to care.
Population-Based Prevention
CDPH is responsible for funding and administering population-based prevention programs and strategies under the BHSA. Four percent of BHSA funding was allocated to CDPH for prevention, and at least 51% of the funds must be used for populations who are 25 years of age and younger.
Given that just 49% of funding is allocated for adults, including older adults, it is imperative for advocates to engage with CDPH and their counties to ensure the continuation of prevention strategies and programs targeted at older adults.
Uplifting the Needs of Older Adults in Stakeholder Meetings
Under BHSA, there are several new stakeholder meetings to track and monitor implementation. It is important that older adult advocates are engaged in these spaces. These stakeholder meetings include, for example: Behavioral Health Planning Council at DHCS, Commission for Behavioral Health, CalHHS Behavioral Health Taskforce, and the Behavioral Health Stakeholder Advisory Committee at DHCS. These meetings are generally open to the public, offer public comment, and meet regularly. See resources below for more information.
Justice in Aging is actively monitoring commenting opportunities for BHSA. To stay updated on California Behavioral Health updates check back here and email us at info@justiceinaging.org to join our California Older Adults Behavioral Health listserv.
Other Resources
Endnotes
California Department of Aging Community Assessment of Older Adults, 2023. ↑
Office of the U.S. Surgeon General, Our Epidemic of Loneliness and Isolation: The U.S. Surgeon General’s Advisory on the Healing Effects of Social Connection and Community, p. 19. ↑
CDPH, Older Adult Suicide in California 2021 Fact Sheet. ↑
Id. ↑
Centers for Disease Control, Drug & Alcohol Deaths on the Rise Among Older Americans. ↑
Insure the Uninsured Project, California’s Behavioral Health Older Adults Survey Report (2025).↑
Michelle M. Doty et. al., How Discrimination in Health Care Affect Older Americans, and What Health Systems and Providers Can Do, Commonwealth Fund. ↑
California Department of Aging, Survey of LGBTQIA+ Older Adults in California: From Challenges to Resilience Summary Document. ↑
Ana B. Ibarra, The Fastest-Growing Homeless Population? Seniors, Cal Matters. ↑
Id. ↑
Insure the Uninsured Project, California’s Behavioral Health Older Adults Survey Report (2025). 41.8% of respondents reported lack of behavioral health services targeting older adults, and 38.2% of respondents reported fragmented service delivery and lack of care coordination as significant service gaps. ↑
The state refers to these two bills together as “Behavioral Health Transformation” (BHT). ↑
Department of Health Care Services, Behavioral Health Services Act County Policy Manual, Section 2.A. ↑
Id. Section 2.B. Eligible Adult and Older Adults are those over 26 years of age who (1) Meet criteria specified in WIC Section 14184.402(c) OR (2) have at least one diagnosis of moderate or severe substance use disorder from the most current version of the DSM for Substance-Related and Addictive Disorders, excluding tobacco-related disorders and non- substance-related disorders. ↑
Id. Section 2.B.3. ↑
Id. Section 2.A. ↑
California Department of Public Health, Behavioral Health Transformation. ↑
WIC 5892(d). ↑
CDPH acknowledges that “many counties may be funding population prevention services through other sources” other than BHSA. Therefore, BHSA prevention programs aim to be aligned with local level efforts. California Department of Public Health, Behavioral Health Transformation. ↑
BHSS includes Older adult systems of care. 51% of BHSS funding is required to be used for early intervention programs. DHCS Behavioral Health Policy Manual, Section 7.A.1. ↑
FSP’s provide “individualized, team-based care” for those living with significant behavioral health needs. DHCS Behavioral Health Policy Manual Section, 7.B.1. ↑
Housing interventions include: rental subsidies, operating subsidies, shared housing, family housing, project-based housing, and capital development projects. DHCS, Behavioral Health Transformation. ↑
WIC Section 5806(a). ↑
DHCS Behavioral Health Policy Manual, Section 3.A. ↑
Id. ↑
Drafts of annual updates are submitted by March 31, with final update due no later than June 30. DHCS Behavioral Health Policy Manual, Section 3.A.3. ↑
Id. Section B.1. ↑
