To: Board of Supervisors
Department or Agency Name(s): Sheriff’s Office
Staff Name and Phone Number: Sharon Post, 565-1119
Vote Requirement: Majority
Supervisorial District(s): Countywide
Title:
Title
Grant Funding for Medi-Cal Expansion to the Justice-Involved Population
End
Recommended Action:
Recommended action
A) Authorize the Sheriff-Coroner to accept a Justice-Involved Capacity Building Program grant from the California Department of Health Care Services (DHCS) to support implementation of California Advancing and Innovating Medi-Cal (CalAIM), a statewide mandate to expand Medi-Cal services to the justice-involved population. The Sheriff is also requesting authority to execute grant documents required to accept the award and implement the grant. DHCS has approved a provisional grant award for the Sheriff’s Office in the amount of $3,500,000.
B) Adopt a Resolution to amend the Sheriff’s position allocation list to add 1.0 FTE time-limited Department Information Systems Coordinator (DISC), enabling a reorganization of Sheriff’s IT staff to accommodate the demands of CalAIM implementation. Staff assigned to CalAIM will be funded by the Justice-Involved Capacity Building Program grant. The addition of the DISC will be effective February 6, 2024, through February 5, 2027. No additional County discretionary funding is required.
end
Executive Summary:
In October 2024, California will begin to offer a targeted set of Medicaid services to Medi-Cal eligible incarcerated adults up to 90 days before they are released. California is the first state in the country to do so, 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. Implementation of this expansion in services, called California Advancing and Innovating Medi-Cal, or CalAIM, involves coordination between the Sheriff’s Office, state and county agencies, medical and behavioral health service providers, information technology professionals, and community-based organizations, to establish a reentry process that provides incarcerated adults with the physical and mental health services they need before release, connect them to appropriate service providers for care upon reentry to the community, and ensure that the proper infrastructure is built to allow Medi-Cal billing for services provided. The Sheriff’s Office has been awarded a grant from the California Department of Health Care Services (DHCS) for the planning and capacity-building activities required for successful implementation of the CalAIM mandate. The Sheriff is requesting authorization to accept the grant, develop and modify the implementation plan as needed, execute grant documents needed to implement the grant, manage the grant funds, and add staff needed to begin program implementation.
Discussion:
Background
According to Department of Health Care Services (DHCS) reporting, an estimated 400,000 individuals are released from corrections facilities in California each year, and an estimated 80-90 percent are eligible for Medi-Cal. People who were formerly incarcerated are more likely to experience poor health outcomes; face higher rates of physical and behavioral health diagnoses; and are at higher risk for injury and death as a result of violence, overdose, and suicide compared to those who have never been incarcerated. Individuals leaving incarceration are at increased risk of ending up in the emergency room or requiring costly institutional care and of suffering serious health consequences, including overdose and death.
Evidence suggests that improving health outcomes for this high-needs group depends on focused care management to assess needs and strengths and connecting individuals prior to release with the services they need when they reenter their communities. A provision of Medicaid law (the “inmate exclusion”) prohibits states from using Medicaid funds for health care of incarcerated persons unless they receive inpatient care at a medical facility outside the jail or prison. To make the CalAIM expansion of services possible, California received a waiver that provides DHCS with authority to authorize federal Medicaid matching funds for a targeted set of Medicaid services for eligible, justice-involved persons in the 90-day period prior to their release from a corrections facility. By providing these pre-release and reentry services to eligible incarcerated persons, DHCS aims to improve health outcomes and reduce health disparities for this population.
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.
Pre-Release Medi-Cal Services
The state’s CalAIM goal is to build a bridge to community-based care by providing services up to 90 days prior to release to stabilize health conditions and establish individual plans for community-based care (collectively referred to as “pre-release services”). Pre-release services include the following:
• Reentry care management services
• Physical and behavioral health clinical consultation services (provided telehealth or in person) to diagnose health conditions, provide treatment, and support post-release treatment plans and discharge planning
• Laboratory and radiology services
• Medications and medication administration
• Medication for Substance Use Disorder, including coverage for counseling or behavioral therapies
• Services provided by community health workers with lived experience.
Additional benefits include:
• Covered outpatient prescribed medications and over-the-counter drugs following release.
Correctional facilities are mandated to go-live with pre-release services no sooner than October 1, 2024, and no later than September 30, 2026. The original dates set by the state for program start-up were earlier in 2024, but delayed dates were recently announced by the state.
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 funding has been committed by DHCS; the final allocation will be based on the budget outlined in the Sheriff’s Office implementation plan, which is due March 31, 2024. DHCS will not set a deadline by which funds must be spent, but the Sheriff’s Office will be required to define its own grant period (start and end dates) in both the implementation plan and grant agreement.
Sheriff’s Office Implementation Plan
Among the critical start-up tasks needed to prepare for CalAIM implementation and pre-release services are:
1. building and integrating a Medi-Cal eligibility, billing, and claiming structure and process;
2. integrating CalAIM data sharing requirements into an upgraded jail management system;
3. ensuring in-reach and discharge capacity is sufficient to facilitate community connections between individuals in custody and providers that will provide post-release care;
4. collaboration with county, community, and embedded medical/behavioral health services partners to identify and remedy service gaps and establish pre-release services.
Planning and coordination with associated departments and partners has begun, and the details will be determined as planning progresses. The importance of data management makes Sheriff’s IT staffing critical to the planning process and implementation of the mandate. At this point in time, the Sheriff’s Office has completed an internal evaluation of technical staff that will be needed to manage and conduct project integration and implementation. In order to use staff allocations and funding in the most efficient manners, the Sheriff’s IT Unit has proposed a reorganization that will allow the Office to be as efficient as possible while accomplishing these goals. The plan will add a 1.0 FTE time-limited Department Information Systems Coordinator (DISC), half of which will be assigned to CalAIM and paid for by the grant, and half of which will be dedicated to and funded by Cal-ID, a separate existing funding source. The reorganization of staff will make available the 0.5 FTE DISC and a 0.5 FTE Department Information Systems Specialist (DISS), an existing position that will be reassigned to CalAIM and also paid for by the grant. Each program, Cal-AIM and Cal-ID require both coordinator and technology support, but not on a full-time basis. This opportunity allows both programs to receive the appropriate level of DISC and DISS staffing without increasing costs to the General Fund. For details, please see the attached Position Change Request approved by County Human Resources. Both positions will be dedicated to critical planning and IT support for the CalAIM work. The requested 0.5 FTE DISC will act as the CalAIM technical manager, and the 0.5 FTE DISS will support the DISC. The request before the Board is for a 1.0 FTE, three-year, time-limited DISC that will allow the reorganization of staff to take place (Resolution attached). Given that funding has been committed by DHCS, and due to the critical nature of onboarding IT staff, the Sheriff’s Office is requesting approval of the Resolution to allow recruitment to begin immediately.
One of CalAIM’s major planning components is associated with data management. In order to facilitate the sweeping changes of CalAIM, the Detention Division needs to accelerate plans to use a modern software management system, referred to as a jail management system (JMS). For CalAIM, IT responsibilities require a technical manager and include oversight of: the implementation of a Medi-Cal billing system to be developed by the County’s contracted medical and behavioral health services provider; integration of medical records and Cal-AIM-related data into a JMS; the integration of new CalAIM systems and re-entry programs into a JMS; and ensuring that appropriate and secure data sharing elements and processes are implemented with related County departments and partners. In addition, data and reporting will be an essential component of this program, which will require technical support.
The Sheriff’s Office does not currently have sufficient technical staff with the technical project management experience to deploy and oversee integration of this critical system. Implementing a JMS will require the review of labor workflows, system design and analysis, monitoring of technical configurations designed by the selected JMS software vendor, leading technical meetings with County ISD and vendor staff, and the oversight of important reporting services to meet Federal and State public safety regulations.
Additionally, California Forensic Medical Group (CFMG) and Wellpath (working as CFMG’s management service organization), as providers of medical and behavioral health services to incarcerated persons at the adult detention facilities, will also be developing systems and services required for successful CalAIM implementation. These include:
1. designing operational processes related to Medi-Cal eligibility verification and pre-release care management
2. enhancing current electronic health records to meet new Medi-Cal claims processing guidelines
3. arranging for implementation of a billing service that will maximize County reimbursement payments and provide all reporting to County of Sonoma
4. onboarding new program administration staff
5. designing a change management and training plan for all facilities.
Sonoma’s portion of cost for the above work is $316,056. Grant funds will be used to reimburse CFMG for these costs.
The Sheriff’s Office anticipates that the purchase of additional technology equipment and support will be needed to develop the capacity to perform Medi-Cal required tasks, documentation, and in-reach for the County Health Department and community service providers. Expenses in this area may include, at a minimum, computers, tablets, WiFi enhancement and expanded video visiting capabilities in the adult detention facility. Detention managers also anticipate needing to add more staff under the CalAIM grant, but until the requested DISC project manager is hired, the exact resources needed remain undefined. If additional grant funded positions are determined to be needed, the Sheriff will return to the Board with the request accordingly at a future date.
Strategic Plan:
N/A
Racial Equity:
Was this item identified as an opportunity to apply the Racial Equity Toolkit?
No
Prior Board Actions:
N/A
Fiscal Summary
|
Expenditures |
FY23-24 Adopted |
FY24-25 Projected |
FY25-26 Projected |
|
Budgeted Expenses |
|
$1,500,000 |
$1,000,000 |
|
Additional Appropriation Requested |
$1,000,000 |
|
|
|
Total Expenditures |
$1,000,000 |
$1,500,000 |
$1,000,000 |
|
Funding Sources |
|
|
|
|
General Fund/WA GF |
|
|
|
|
State/Federal |
$1,000,000 |
$1,500,000 |
$1,000,000 |
|
Fees/Other |
|
|
|
|
Use of Fund Balance |
|
|
|
|
General Fund Contingencies |
|
|
|
|
Total Sources |
$1,000,000 |
$1,500,000 |
$1,000,000 |
Narrative Explanation of Fiscal Impacts:
The California Department of Health Care Services (DHCS) approved a provisional grant award amount of $3,500,000. The table above estimates use of the funding over three years, however, the exact timing of the funding uses will depend on the implementation plan, which is due March 31, 2024. Grant funds will be held in the Sheriff’s interest-bearing special revenue fund and transferred to the operational budget as needed through the consolidated budget adjustment process and annual budget development. No local match is required.
The position costs for the 0.5 FTE DISC and 0.5 FTE DISS which will be dedicated to this project are estimated to be approximately $225,00 on an annual basis. This includes estimated interfund rates charged for each 0.5 FTE allocated to the Sheriff’s Office. The position costs and one-time costs for a computer for each are included in the annual grant expenditure estimates above. The known costs for FY 23-24 are $117,525 for approximately 5 months of a 0.5 FTE DISC and the 0.5 FTE DISS, if approved, and $316,056 for the CFMG costs. The remaining $566,419 is being appropriated to prepare for additional work that will occur after the implementation plan is completed. Any unused grant funds will be re-budgeted in FY 24-25.
|
Staffing Impacts: |
|
|
|
|
Position Title (Payroll Classification) |
Monthly Salary Range (A-I Step) |
Additions (Number) |
Deletions (Number) |
|
Department Information Systems Coordinator (DISC) |
$8,928 |
1.0 FTE |
|
|
|
|
|
|
|
|
|
|
|
Narrative Explanation of Staffing Impacts (If Required):
To accomplish the goals of CalAIM and maintain critical IT functions, a reorganization within the Sheriff’s Office IT Unit is proposed and outlined in detail in the attached Program Change Request (PCR). As part of the reorganization, this Board Item is requesting the addition of 1.0 FTE DISC allocation. Total staff allocated to and funded by the grant will be 0.5 FTE DISC and an existing 0.5 FTE DISS. The remaining 0.5 FTE of each of the grant positions will be assigned to other existing work, through the reorganization described in the PCR.
Attachments:
1. Approved Program/Position Change Request (PCR)
2. Resolution amending the Sheriff’s position allocation list to add one time-limited Department Information Systems Coordinator (DISC), effective February 6, 2024
3. PATH Funding: Justice-Involved Reentry Initiative Capacity Building Program Guidance, June 2023
Related Items “On File” with the Clerk of the Board:
N/A