To: Board of Supervisors
Department or Agency Name(s): Sheriff’s Office & Health Services
Staff Name and Phone Number: Sharon Post x1119 and Wendy Wheelwright x2100
Vote Requirement: Majority
Supervisorial District(s): Countywide
Title:
Title
New positions to support California Advancing and Innovating Medi-Cal (CalAIM)
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Recommended Action:
Recommended action
A) Adopt a Resolution amending the Sheriff’s Office Department Allocation List to add 1.0 Full Time Equivalent (FTE) Administrative Aide, effective February 4, 2025, to support the mandated California Advancing and Innovating Medi-Cal (CalAIM) Justice-Involved Initiative.
B) Adopt a Resolution amending the Department of Health Services Department Allocation List to add 2.0 Full Time Equivalent (FTE) Senior Client Support Specialists, effective February 4, 2025, to support the mandated California Advancing and Innovating Medi-Cal (CalAIM) Justice-Involved Initiative.
end
Executive Summary:
These position resolutions are being requested to provide staff to support the new California Advancing and Innovating Medi-Cal (CalAIM) Justice-Involved Initiative at the Sheriff’s Office Main Adult Detention Facility. CalAIM is a new initiative developed by the State of California Department of Healthcare Services to improve access to services and care for Medi-Cal enrollees. Three new full time FTE positions will be needed to provide administrative and case management services at the Sonoma County Main Adult Detention Facility as required by the mandate. Grant funding, already approved in the FY24-25 Budget, will fund the positions through FY 25-26. Then, Medi-Cal funding is anticipated to cover the costs of these positions once CalAIM goes live, and the grant funding is exhausted. The grant was preliminarily approved late last spring, allowing time for grant funds to be appropriated in FY 25-26 to cover the various aspects of program implementation. However, this grant approval did not occur prior to the deadline to add new positions to the FY 24-25 budget (February 2024), which prevented the addition of new Cal-AIM position allocations in time for budget adoption.
The staffing requests are associated with state law (Welfare and Institutions Code section 14184.102) mandates that Department of Health Care Services (DHCS) administer, and that corrections facilities and Medi-Cal behavioral health delivery systems implement the CalAIM Justice-Involved Initiative. The state mandate is associated with federal Medicaid 1115 demonstration waiver approved by the Centers for Medicare & Medicaid Services (CMS) which assumes will be renewed after the waiver expires on December 2026.
Discussion:
In 2023, California became the first state in the nation approved to offer a targeted set of Medicaid services to youth and adults in state prisons, county jails, and youth correctional facilities for up to 90 days prior to release with the goal of addressing the unique and considerable health care needs of justice-involved individuals, improving health outcomes, delivering care more efficiently, and advancing health equity across the state. Through a federal Medicaid 1115 demonstration waiver approved by the Centers for Medicare & Medicaid Services (CMS), the Department of Health Care Services (DHCS) has partnered with state agencies, counties, and community-based organizations to establish an expanded system for providing enhanced care. Implementation of the mandated expansion in services, called California Advancing and Innovating Medi-Cal, or CalAIM, involves establishing a reentry process that provides incarcerated adults with the physical and mental health services they need before release, and connecting them to appropriate service providers for care upon reentry to the community.
Eligible inmates will receive services up to 90 days before their release to stabilize their behavioral health conditions and establish a plan for their community-based care. The Sheriff’s Office intends to go-live with the provision of enhanced services in January 2026. The deadline to go live is September 30, 2026.
State law (Welfare and Institutions Code section 14184.102) mandates that DHCS administer, and that corrections facilities and Medi-Cal behavioral health delivery systems implement the CalAIM Justice-Involved Initiative. Any potential federal changes present a lower risk to the County than failing to comply with the mandate.
Grant Funding for Planning and Implementation
DHCS made grant funding available through its Justice-Involved Providing Access and Transferring Health (PATH) Round 3 Capacity Building Program to support planning and implementation of justice-involved reentry services. Funding may be used to support investments in personnel, capacity, and/or IT systems that are needed for collaborative planning and structural improvements required for implementation of CalAIM service processes. The Sheriff’s Office submitted a PATH3 Justice-Involved grant request in July 2023. DHCS approved a provisional award amount of $3,500,000. The Board authorized the Sheriff to accept the grant on January 30, 2024, and the revenue and expenditures associated with these positions were included in the approved FY 24-25 Budget.
Sheriff’s Office Position Addition
The Sheriff’s Office Detention Division requests the addition of 1.0 FTE Administrative Aide to address the new CalAIM workload. Examples of this work include CalAIM data tracking and reporting, maintaining the referral process to ensure Medi-Cal enrollment of incarcerated persons, verification of Medi-Cal coverage of incarcerated adults, collaborating with custody and medical/behavioral health staff for various activities, activating the 90-day Pre-Release Services using the State’s correctional facility portal, and serving as the Sheriff’s liaison among the various stakeholders and community partners. This body of work cannot be absorbed by existing staff. If approved, this position would begin in FY 24-25 with salary and benefit expenses covered by the Sheriff’s Office Justice-Involved Capacity Building Program PATH 3 grant through FY 25-26. The services performed by this position are mandated, but are not directly claimable to Medi-Cal. Once full implementation of CalAIM is established (estimated in January 2026), the Sheriff’s Office should be able to claim and receive Medi-Cal reimbursement under CalAIM for many services that are already provided in the jail at the County’s expense. Though the amount of reimbursement is unknown at this time, it is expected to offset the addition of the Administrative Aide position after the grant period ends.
Department of Health Services Position Additions
Department of Health Services (DHS), Behavioral Health Division requests the addition of 2.0 FTEs to add Senior Client Support Specialist positions to the new, CalAIM “Whole Person Care Team” working in the Main Adult Detention Facility (MADF). The increased staffing will provide embedded pre-release services as mandated under CalAIM. The start-up and expansion timeline will be aligned with DHCS required CalAIM implementation deadlines. The new positions will be able to connect incarcerated adults to services prior to release, resulting in greater continuity of care for incarcerated persons post-release and improved efficiencies for the treatment teams. The embedded Senior Client Support Specialists will perform Enhanced Care Management (ECM) screenings, housing assessments, oversee completion of release of information (ROI) forms, and develop care plans. The Specialists will develop transition plans, identify in-reach community resources, perform behavioral health intake assessments, and provide linkages and warm handoffs to County Behavioral Health and community partners. Prior to release they will also confirm post-release appointments and arrange transportation for released individuals as needed.
The Sonoma County Sheriff’s Office reports the following data for December regarding anticipated volume of need. During this period, the total number of Mental Health (MH) involved inmates was 358 (which is 49.44% of the total inmate population). All MH involved inmates who fall within the Medi-Cal income levels are eligible for this mandated program (which is the vast majority). Conservatively, 75% of inmates would fall into the 90-day window at any given time, given the shorter sentences of those serving in the jail.
Conservatively assuming that half of the eligible inmates would agree to participate (it will most likely be more as it could contribute to earlier releases), then a volume of 134 potential participants is anticipated. Best practices indicate that a caseload size of no more than 35 is recommended, which can be stretched slightly by running group models. In sum, the anticipated volume of need exceeds the requested 2.0 FTE.
One Senior Client Support Specialist position will begin in FY 24-25, and the second position will begin in FY 25-26. Salary and benefit expenses for both positions will be funded through FY 25-26 by the Sheriff’s Office Justice-Involved Capacity Building Program PATH 3 grant. These services are claimable to Medi-Cal at a bundled rate, with reimbursements to the Sheriff’s Office expected to be sufficient to fund the cost of the positions when the grant period ends. The Sheriff’s Office will make workspace available at MADF and will use grant funds for any furniture or equipment needs.
Strategic Plan:
This item directly supports the County’s Five-year Strategic Plan and is aligned with the following pillar, goals, and objectives. These Medi-Cal resources are new, and made available through the implementation of the CalAIM Justice-Involved Initiative at the Sheriff’s Office Detention Division in collaboration with DHS Behavioral Health Division.
Pillar: Healthy and Safe Communities
Goal: Expand integrated system of care to address gaps in services to the County’s most vulnerable
Objective: Create a “no wrong door” approach where clients who need services across multiple departments and programs are able to access the array of services needed regardless of where they enter the system.
Pillar: Healthy and Safe Communities
Goal: Reduce the County’s overall homeless population by 10% each year by enhancing services through improved coordination and collaboration.
Objective: Increase investment in programs that treat underlying causes of homelessness, including substance abuse, mental illness, poverty, and lack of affordable housing.
Pillar: Healthy and Safe Communities
Goal: Continue to invest in public safety so that residents and visitors feel safe in our community.
Objective: Expand detention alternatives with the goal of reducing the jail population, from pre-pandemic levels, by 15% at the end of 2022, while simultaneously reducing recidivism amongst the supervised offender population.
Racial Equity:
Was this item identified as an opportunity to apply the Racial Equity Toolkit?
No
Prior Board Actions:
1/30/24 - Approval of Grant Funding for Medi-Cal Expansion to the Justice-Involved Population
Fiscal Summary
|
Expenditures |
FY24-25 Adopted |
FY25-25 Projected |
FY26-27 Projected |
|
Budgeted Expenses |
$141,545 |
$520,232 |
$539,314 |
|
Additional Appropriation Requested |
|
|
|
|
Total Expenditures |
$141,545 |
$520,232 |
$539,314 |
|
Funding Sources |
|
|
|
|
General Fund/WA GF |
|
|
|
|
State/Federal |
$141,545 |
$520,232 |
$539,314 |
|
Fees/Other |
|
|
|
|
Use of Fund Balance |
|
|
|
|
General Fund Contingencies |
|
|
|
|
Total Sources |
$141,545 |
$520,232 |
$539,314 |
Narrative Explanation of Fiscal Impacts:
Salary and benefit expenses for the three new positions will be funded through FY 25-26 by the Sheriff’s Justice-Involved Capacity Building Program Grant and subsequently through the leveraged federal financial participation dollars that the positions and pre-release services will bring down through the Medi-Cal claiming processes.
The DHS positions are directly related to new services required by the mandate and are billable to Medi-Cal. For the Administrative Aide, we anticipate that certain health services that are currently funded by the General Fund will now be funded by Medi-Cal, therefore generating savings needed to cover this position. The grant funding will provide time for the fiscal analysis and impacts of the program to allow for evaluation of the overall program and required resources. Any shortage between the anticipated and actual savings will be addressed by the Sheriff’s Office through budget reductions in detention administrative support roles.
Revenue and expenditures for these positions in the current year are included in the approved FY 24-25 Budget. Future year funding will be included in the appropriate year budgets, assuming a 3% Cost of Living Adjustment (COLA).
|
Staffing Impacts: |
|
|
|
|
Position Title (Payroll Classification) |
Monthly Salary Range (A-I Step) |
Additions (Number) |
Deletions (Number) |
|
Administrative Aide |
$6,204 - $7,540 |
1.0 |
|
|
Senior Client Support Specialist |
$6,665 - $8,102 |
2.0 |
|
|
|
|
|
|
Narrative Explanation of Staffing Impacts (If Required):
The 1.0 FTE Administrative Aide will be assigned to the Sheriff’s Office Detention Division and will report to the Administrative Lieutenant. The position will have no direct reports. This is a new position which will alleviate pressure and reduce excess workload for an existing Administrative Aide who has been performing CalAIM compliance requirements in addition to normal workload in an arrangement that is not sustainable in its current form.
The 2.0 FTE Senior Client Support Specialists will be assigned to the DHS Behavioral Health Division and will report to the Whole Person Care Team Manager The positions will have no direct reports. These new positions will be able to connect inmates to services prior to release, resulting in greater efficiencies for the receiving treatment teams, and reduction in some workload on those teams.
Attachments:
Resolution to Amend the FY 24-25 Department Allocation list for the Sheriff’s Office
Resolution to Amend the FY 24-25 Department Allocation list for the DHS Behavioral Health Division
Related Items “On File” with the Clerk of the Board:
Grant Funding for Medi-Cal Expansion to the Justice Involved Population, Approved by the Board 1/30/2024
Sheriff’s Program Change Request (PCR) to add 1.0 FTE Administrative Aide
DHS Behavioral Health Division Program Change Request (PCR) to add 2.0 FTE Senior Client Support Specialists