Establishing a Local Wellness Fund: Lessons from the California Accountable Communities for Health Initiative

Originally published in 2019 and updated in 2025, this brief provides practical guidance for designing, governing, and sustaining locally controlled wellness funds as part of the Accountable Communities for Health (ACH) model. At its heart, the concept remains simple but powerful: pool and align resources across sectors, center community voice in decisions, and create a lasting financial structure that supports equity-focused systems change.

The updated edition draws on new case examples and the experiences of ACH collaboratives across California. It highlights:

• Why Wellness Funds Matter – how they break down silos, prevent “wrong pocket” problems, and provide flexibility and shared governance.

• Wellness Funds in Action – real-world examples, including the One San Pedro Alliance’s resident-led participatory budgeting process and the East San José PEACE Partnership’s collaboration with a foundation to manage funds.

• Fiscal and Administrative Models – approaches such as blending, braiding, and aligning funds, plus practical guidance on selecting the right administrative model.

• Steps for Development – a ten-step roadmap for building a fund, from articulating a value proposition to formalizing governance agreements.

• Recommendations for Policymakers and Funders – strategies for supporting local wellness funds, including pilot investments, shared-savings arrangements, and policy levers that keep resources accountable to communities.

This resource is designed for multisector collaborative leaders, funders, and policymakers who are working to embed equity and sustainability in their communities. It frames wellness funds not as a “magic bullet,” but as a living strategy—tested, adapted, and refined in partnership with residents—to align resources with community priorities and build more resilient systems.