To: Board of Supervisors
Department or Agency Name(s): County Executive’s Office
Staff Name and Phone Number: M. Christina Rivera, Andrew McLaughlin 565-3776
Vote Requirement: 4/5th
Supervisorial District(s): Countywide
Title:
Title
Jail Medical Feasibility Study
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Recommended Action:
Recommended action
A) Authorize the County Executive to execute a Memorandum of Understanding (MOU) with the Golden State Finance Authority (GSFA) to provide cost reimbursement for participation in a regional jail medical care feasibility study.
B) Approve allocation of $149,985 from General Fund Contingencies to fund Sonoma County’s share of the costs for participating in the jail medical care feasibility study.
C) Adopt a Budget Resolution adjusting the Non-Departmental FY 2025-26 Adopted Budget by $184,985 to fund Sonoma County’s portion of the jail medical care feasibility study (4/5ths vote).
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Executive Summary:
Counties throughout California are increasingly challenged by the rising cost and complexity involved in the provision of required medical care to individuals housed in county jails. Through the proposed MOU, Sonoma County will partner with the GSFA to fund and participate in a coordinated evaluation of long-term jail medical care alternatives. North Bay regional partners in the study include Napa County and Solano County.
Staff is recommending the use of General Fund contingencies in the amount of $149,985 to support this work as this expense was not anticipated during FY 25-26 budget development and has emerged in recent months as a topic of focused study.
Discussion:
As stated previously, counties throughout California are challenged by the rising cost and complexity of providing legally required medical care to individuals housed in county jail facilities. Many counties face persistent staffing shortages, escalating contract and litigation costs, and are challenged to maintain compliance with state and national care standards. In Sonoma, the Main Adult Detention Facility adheres to the California Board of State and Community Corrections regulations and is accredited by the National Commission on Correctional Health Care. It requires these standards from its service providers.
Publicly available data and county experience indicate that contract costs for jail medical services have increased from one contract period to the next, alongside expanded regulatory requirements and heightened expectations for specialty and behavioral health care. Limited service provider options further constrain counties’ options should a particular provider no longer be available.
In response to these challenges, the Rural County Representatives of California (RCRC), in partnership with a public organization called Public Risk Innovation, Solutions and Management (PRISM), a member-directed risk management joint powers authority, convened five regional task forces in early 2025 composed of County Executive and Administrative Officers (CEOs and CAOs). Sonoma County participated via representation from Assistant County Executive on the task force. The purpose of these task forces was to explore long-term strategies for improving the delivery, quality, cost-effectiveness, and risk management of jail care, including the potential for regional collaboration.
Following a series of working group meetings with each region of California, the Golden State Finance Authority (GSFA), an affiliate of RCRC, issued Request for Proposals (RFPs) on October 13, 2025. The purpose of the RFP is to procure a qualified consultant to conduct a feasibility study evaluating alternative models for jail medical care delivery across five defined regions of California, encompassing a total of 26 participating counties. A map of these regions and participating counties is attached with this item.
The RFP submission period closed on December 12, 2025, resulting in two qualifying proposals. GSFA conducted an internal evaluation process in consultation with each regional working group in early January, 2026. Through this process, regional working groups identified preferred consultants to support the study within their respective regions.
Under the structure described in the MOU, the GSFA will serve as the contracting entity and program facilitator, will convene coordination meetings between county staff and the selected consultant, and will act as the fiscal intermediary responsible for processing and paying consultant invoices using the funds contributed by participating counties, and requested with this item. The feasibility study will be performed exclusively by the selected consultant, and the MOU will become effective only upon execution by all participating counties within the region.
The costs associated with this MOU and the work done according to it was an unplanned, unbudgeted expense that has only emerged in the last several months as a topic of consideration. Due to the multijurisdictional nature of the work and the work groups being led and staffed by the County Executive’s Office, the County Executive’s Office will continue to manage this initiative, in consultation with the Sheriff’s Office and Department of Health Services, or other operating department as appropriate in the future as the study proceeds. Due to this being an unplanned initiative this year, staff are recommending the use of General Fund Contingencies to participate in this regional effort.
Strategic Plan:
N/A
Racial Equity:
Was this item identified as an opportunity to apply the Racial Equity Toolkit?
No
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Prior Board Actions:
N/A
Fiscal Summary
|
Expenditures |
FY25-26 Adopted |
FY26-27 Projected |
FY27-28 Projected |
|
Budgeted Expenses |
|
|
|
|
Additional Appropriation Requested |
$149,985 |
|
|
|
Total Expenditures |
$149,985 |
|
|
|
Funding Sources |
|
|
|
|
General Fund/WA GF |
|
|
|
|
State/Federal |
|
|
|
|
Fees/Other |
|
|
|
|
Use of Fund Balance |
|
|
|
|
General Fund Contingencies |
$149,985 |
|
|
|
Total Sources |
$149,985 |
|
|
Narrative Explanation of Fiscal Impacts:
A General Fund Contingencies request in the amount of $149,985 is included with this action to fund Sonoma County’s share of the costs associated with the jail medical care feasibility study. The full amount of Sonoma County’s share is requested, will be encumbered, and will roll forward into out years as needed to support the study.
Narrative Explanation of Staffing Impacts (If Required):
N/A
Attachments:
Golden State Finance Authority - County MOU
Bay Area Region Cost Allocation Summary
Map - Diagram of California regions involved in the feasibility study
Budget Resolution
Related Items “On File” with the Clerk of the Board:
None.