To: Board of Supervisors of Sonoma County
Department or Agency Name(s): Department of Health Services
Staff Name and Phone Number: Barbie Robinson, 565-7876
Vote Requirement: Majority
Supervisorial District(s): Countywide
Title:
Title
County Medical Services Program Local Indigent Care Needs and COVID-19 Emergency Response Grants
End
Recommended Action:
Recommended action
A) Authorize the Director of Health Services, or designee, to execute a grant agreement with the County Medical Services Program Governing Board to accept $1,500,000 in revenue to develop and implement coordinated continuity of care services for homeless clients with medical, behavioral health, and substance use disorder challenges as they are released from the County’s Adult Detention Facility and local acute care facilities for the period July 1, 2020 through September 28, 2023.
B) Authorize the Director of Health Services, or designee, to execute a grant agreement with the County Medical Services Program Governing Board to accept $997,243 in revenue to support the County’s COVID-19 response by expanding service delivery, with a focus on homeless individuals, for the period June 1, 2020 through November 30, 2021.
C) Adopt a personnel resolution amending the Department of Health Services allocation list, effective August 11, 2020, to add 1.0 full-time equivalent time-limited Program Planning and Evaluation Analyst position through February 28, 2023.
end
Executive Summary:
On December 17, 2019 the Department of Health Services requested and the Board of Supervisors approved submission of a grant application to the County Medical Services Program Governing Board requesting $1,500,000 to develop and implement coordinated continuity of care services for homeless clients with medical, behavioral health, and substance use disorder challenges as they are released from the County's Adult Detention Facility and local acute care facilities. On March 26, 2020 the Department received a notice of award from the County Medical Services Program Governing Board stating that Sonoma County has been awarded a three-year Local Indigent Care Needs Grant in the amount of $1,500,000.
On May 13, 2020 the Department of Health Services submitted an application to receive COVID-19 Emergency Response Grant funding from the County Medical Services Program Governing Board. On June 2, 2020 the Department received a notice of award from the County Medical Services Program Governing Board stating that Sonoma County has been awarded a one-year COVID-19 Emergency Response Grant in the amount of $997,243. The COVID-19 Emergency Response Grant is intended to assist County Medical Services Program counties in addressing the needs of various low income populations with or at-risk of COVID-19 conditions.
The funding under these grant awards will leverage the ACCESS Sonoma program by supporting activities to protect vulnerable and homeless individuals from COVID-19 and provide greater flexibility for the target populations to be served under this program. The services and individuals aided by these grants differ from the COVID-19 Response Plan potentially funded by the Federal Emergency Management Assistance (FEMA) and Coronavirus Aid, Relief, and Economic Security (CARES) Act that will be brought forth to the Board for approval on August 18, 2020.
The Department of Health Services is requesting Board approval to execute both the Local Indigent Care Needs Grant and the COVID-19 Emergency Response Grant from the County Medical Services Program Governing Board.
Discussion:
Local Indigent Care Needs Grant - $1,500,000
On December 17, 2019 the Department of Health Services requested and the Board of Supervisors approved submission of a grant application to the California State County Medical Services Program Governing Board requesting $1,500,000 to develop and implement coordinated continuity of care services for homeless clients with medical, behavioral health, and substance use disorder challenges as they are released from the County's Adult Detention Facility and local acute care facilities. On March 26, 2020 the Department received a notice of award from the County Medical Services Program Governing Board stating that Sonoma County has been awarded a three-year Local Indigent Care Needs Grant in the amount of $1,500,000.
Grant funding will support enhanced coordination of care and provision of supportive housing services for some of the County’s most vulnerable inhabitants, consistent with the grant goals. Specifically, the grant will fund:
- A contract with an experienced community based organization to provide approximately ten permanent supportive housing beds for homeless indigent clients with medical, behavioral health, and/or substance use disorder challenges being released from the Adult Detention Center, hospitals, and local acute care facilities. The target population will be individuals who have come to inpatient care or criminal justice healthcare systems from homeless encampments and who are at-risk of returning to these homeless encampments and are in a medically fragile or vulnerable condition.
- A time limited, community-wide discharge planner (Program Planning and Evaluation Analyst) to serve as a single hub for discharge planners from the jail, hospitals, psychiatric, substance use disorder treatment and other local acute care facilities. This position will support a timely, well-coordinated and confirmed hand off to continuity of care partners. This position will work closely with County and community service agencies who are working with the County’s general homeless and high-needs populations and will be an active member of the ACCESS Sonoma Interdepartmental Multi-Disciplinary Team.
- Integration of the community-wide discharge planner into the ACCESS Sonoma Interdepartmental Multi-Disciplinary Team to support care management of participating clients.
All grant-funded permanent supportive housing will be allocated to individuals who are homeless at the time of discharge from inpatient care. In addition, a primary focus of the Discharge Planner will be to work with care managers to find housing and or shelter for homeless individuals who are discharged from inpatient care. The overall goal of the Department’s grant-related efforts is to prevent those individuals who are homeless at the time of inpatient discharge from returning to homelessness and to improve their health outcomes.
The addition of a Discharge Planner will help many providers across the County to plan and coordinate continuity of care resulting in improved health outcomes for our homeless and high-needs residents being discharged from inpatient treatment. An October 24, 2019 discharge planning and coordination meeting hosted by the Department of Health Services and attended by over 60 community partners identified this position as a very high priority to integrate the currently siloed discharge planning system. This meeting was attended by local hospitals, federally qualified health care centers, substance use disorder treatment centers, law enforcement agencies, behavioral health providers, and homeless services providers.
The addition of permanent supportive housing beds will address one of the County’s most pressing problems. Sonoma County is among the top three suburban counties in America for the total number of homeless residents and Sonoma County has a per-capita homelessness rate that is 77 percent higher than the next highest suburban county in America.
DHS believes the model is sustainable beyond the 36-month grant implementation period. Cost savings through streamlined care coordination and service delivery, implementing a pay for success model supportive housing program, strengthening County Safety Net partnerships to reduce siloed services, and rapid service connection to reduce preventable illnesses and mitigate costs for existing health problems can be reinvested in ACCESS Sonoma and the Navigator position.
Grant awardees are required to provide in-kind and/or matching funds in the amount of no less than ten percent of the grant program amount. The total In-Kind match for the three-year project period is $150,000. The Department of Health Services will provide $50,000 in In-Kind match per year. This includes $12,487 per year for the 0.07 FTE Continuity of Care Navigator and $37,513 per year for a 0.19 FTE Program Manager who will serve as the LICN Project Manager and coordinate ACCESS Sonoma.
The Program Manager is a currently funded position allocation in the Interdepartmental Multi-Disciplinary Team with administrative oversight of the entire ACCESS Sonoma program, and provides support for all of the Cohort Managers as well as the Discharge Navigator. This position is expected to spend approximately one day per week (19%) providing administrative support to the LICN Continuity of Care cohort and will coordinate the IMDT in support of the Navigator and Continuity of Care program. The budgeted cost of time dedicated to the LICN Cohort is $37,513 per year. The source of the In-kind match is the existing funding for the ACCESS Sonoma Interdepartmental Multi-Disciplinary Team which is comprised Whole Person Care and 1991 Mental Health realignment.
Planned Local Indigent Care Needs Grant Expenditures Summary:
- Contracted housing services: $750,000
- Staffing and direct staffing expenditures: $650,100
- Administrative expenses: $99,900
COVID-19 Emergency Response Grant - $997,243
On May 13, 2020 the Department of Health Services submitted an application to receive COVID-19 Emergency Response Grant funding from the County Medical Services Program Governing Board. On June 2, 2020 the Department received a notice of award from the County Medical Services Program Governing Board stating that Sonoma County has been awarded a one-year COVID-19 Emergency Response Grant in the amount of $997,243. On December 17, 2019 the Department of Health Services requested and the Board of Supervisors approved submission of a grant application to the County Medical Services Program Governing Board requesting $1,500,000 to develop and implement coordinated continuity of care services for homeless clients with medical, behavioral health, and substance use disorder challenges as they are released from the County's Adult Detention Facility and local acute care facilities. On March 26, 2020 the Department received a notice of award from the County Medical Services Program Governing Board stating that Sonoma County has been awarded a three-year Local Indigent Care Needs Grant in the amount of $1,500,000.
On May 13, 2020 the Department of Health Services submitted an application to receive COVID-19 Emergency Response Grant funding from the County Medical Services Program Governing Board. On June 2, 2020 the Department received a notice of award from the County Medical Services Program Governing Board stating that Sonoma County has been awarded a one-year COVID-19 Emergency Response Grant in the amount of $997,243. The COVID-19 Emergency Response Grant is intended to assist County Medical Services Program (CMSP) counties in addressing the needs of various low income populations with or at-risk of COVID-19 conditions.
The funding under this grant award will leverage the ACCESS Sonoma program by supporting activities to protect vulnerable and homeless individuals from COVID-19 and provide greater flexibility about the target populations to be served under this program than the Federal Emergency Management Assistance (FEMA) and Coronavirus Aid, Relief, and Economic Security (CARES) Act funding for the COVID-19 Response Plan that will be brought forth to the Board for approval on August 18, 2020.
Sonoma County will focus COVID-19 Emergency Response Grant activities on homeless individuals with or at-risk of COVID-19 by providing outreach and intensive care coordination to bring these individuals into the safety net delivery system including connecting them with food and cash assistance programs, disability and social security services, substance use disorder and mental health services, primary care services, employment services, transportation services, and other programs to improve the well-being and/or self-sufficiency. This funding provides greater flexibility in that the homeless individuals with or at-risk of COVID-19 that will be served under this program do not have to meet the specific COVID-19 criteria to be eligible for the Federal Emergency Management Assistance (FEMA) reimbursement.
In 2019, Sonoma County had the highest per capita homeless population of any other comparable jurisdiction of its size in the United States. According to the 2019 Homeless Count, chronically, homeless individuals experience more severe, negative, health outcomes due to their prolonged experience of homelessness they often lack access to economic, health, and housing resources and supports. In Sonoma County only 27 percent of the homeless population are enrolled in Medi-cal. Nearly 80 percent are unemployed, almost 40 percent report alcohol and drug abuse, 35 percent have psychiatric conditions, 23 percent report chronic health conditions, and 1 in 4 report a physical disability. The Centers for Disease Control and Governor Newsom identified the homeless population as a specific high-risk population and recommend alternate temporary housing to support isolation and quarantine. A special focus is seniors, age 65 and older. In the current Coordinated Entry System, 294 individuals (10% of total served) identified as 65 or older.
The Sonoma County Safety Net Collaborative is comprised of the Department of Health Services, Human Services Department, Child Support Services, Probation, Community Development Commission (housing and homeless services department), Sheriff’s Office, Public Defender, District Attorney, and the Courts. The Board of Supervisors established the ACCESS Initiative and the Interdepartmental Multi-Disciplinary Team (IMDT) to conduct extensive outreach and intensive care management to homeless individuals. The Interdepartmental Multi-Disciplinary Team (IMDT) care delivery model will be employed to coordinate and provide an array of services to homeless individuals to mitigate the spread of COVID-19 amongst homeless individuals and the community as a whole. COVID-19 services include outreach and engagement; health education; referral for social, medical, and behavioral services; screening and referral to non-congregate housing; provision of temporary quarantine/isolation housing; food; transportation and case management; and ultimate placement into permanent supportive housing or affordable housing.
The COVID-19 Emergency Response Grant funding will be used to fund personnel and non-personnel for a period of six months. Due to the short duration of the project and the emergency response necessary to mitigate the Coronavirus transmission in the homeless population, the department is planning to hire extra help staff for the six-month duration of this project. As future funding may become available, extra help staff may be kept to continue supporting the COVID-19 response.
Supportive Quarantine and Outreach: 53 hotel vouchers for 14 day periods are allocated to provide quarantine for COVID exposed individuals and reverse isolation for vulnerable persons. The CMSP CERG funding will allow DHS to expand its COVID-19 shelter response (53 hotel vouchers) to the homeless population, without the restrictive FEMA eligibility requirements. The CMSP CERG funding complements the work done by ACCESS Sonoma/IMDT and HEART Teams with an emphasis on the mitigating the COVID-19 risk in the homeless population. Gift cards for meals and essential personal items such as clothing, first aid materials, and over-the-counter medications are available for outreach workers to distribute. Bulk non-perishable food items, storage totes/bins, face masks, and hand sanitizer are also funded to assist with basic personal needs and to mitigate COVID transmission risks.
Expected Outcomes: Staff will provide outreach and engagement services to 350+ individuals, and integrated care management to serve 105+ individuals. COVID risks will be mitigated through testing, quarantine, reverse isolation, rapid connection to health care, and distribution of masks and sanitizer. Personalized care plans using internationally known evidenced based Adult Needs and Strengths Assessment tool resulting in addressing individual barriers and successful connections to housing, medical, behavioral, and treatment needs.
Planned COVID-19 Emergency Response Grant Expenditures Summary:
- Supportive quarantine and outreach: $208,630
- Staffing and direct staffing expenditures: $658,538
- Administrative expenses: $130,075
Prior Board Actions:
On December 17, 2019 the Board approved submission of a grant application to the California State County Medical Services Program Governing Board requesting $1,500,000 to develop and implement coordinated continuity of care services for homeless clients with medical, behavioral health, and substance use disorder challenges as they are released from the County's Adult Detention Facility and local acute care facilities.
Fiscal Summary
|
Expenditures |
FY 20-21 Adopted |
FY 21-22 Projected |
FY 22-23 Projected |
|
Budgeted Expenses |
|
|
|
|
Additional Appropriation Requested |
1,387,243 |
480,000 |
480,000 |
|
Total Expenditures |
1,387,243 |
480,000 |
480,000 |
|
Funding Sources |
|
|
|
|
General Fund/WA GF |
|
|
|
|
State/Federal (CMSP) |
1,387,243 |
480,000 |
480,000 |
|
Fees/Other |
|
|
|
|
Use of Fund Balance |
|
|
|
|
Contingencies |
|
|
|
|
Total Sources |
1,387,243 |
480,000 |
480,000 |
Narrative Explanation of Fiscal Impacts:
Local Indigent Care Needs Grant
Appropriations and expenditures related to funding received through the County Medical Services Program Local Indigent Care Needs Grant will be added to the fiscal year 2020-2021 budget via the consolidated budget adjustments process following approval of the grant award. Future year funding will be included in the appropriate year budgets. It is anticipated that grant funding will be received as follows: FY 20-21 - $390,000; FY 21-22 - $480,000; FY 22-23 - $480,000, and FY 23-24 - $150,000. The In-kind match for the three-year project period is $150,000. The Department of Health Services will provide $50,000 in In-Kind match per year. This includes $12,487 per year for the 0.07 FTE Continuity of Care Navigator and $37,513 per year for a 0.19 FTE Program Manager who will serve as the LICN Project Manager and coordinate ACCESS Sonoma. The source of the In-kind match is the existing funding for the ACCESS Sonoma Interdepartmental Multi-Disciplinary Team which is comprised Whole Person Care and 1991 Mental Health realignment.
COVID-19 Emergency Response Grant
Appropriations and expenditures related to the $997,243 in funding received through the County Medical Services Program COVID-19 Emergency Grant will be added to the fiscal year 2020-2021 budget via the consolidated budget adjustments process following approval of the grant award.
|
Staffing Impacts: |
|
|
|
|
Position Title (Payroll Classification) |
Monthly Salary Range (A-I Step) |
Additions (Number) |
Deletions (Number) |
|
|
|
|
|
|
|
|
|
|
Narrative Explanation of Staffing Impacts (If Required):
N/A
Attachments:
Attachment 1 - County Medical Services Program Local Indigent Care Needs Grant
Attachment 2 - County Medical Services Program COVID-19 Emergency Response Grant
Attachment 3 - Personnel Resolution
Related Items “On File” with the Clerk of the Board:
None