To: Sonoma County Board of Supervisors
Department or Agency Name(s): Sonoma County Sheriff’s Office
Staff Name and Phone Number: Sheriff Engram, 565-2650, Connie Newton, 565-8884
Vote Requirement: Majority
Supervisorial District(s): Countywide
Title:
Title
Wellpath Amendment and MAT Agreement for Cal-AIM Justice Involved Initiative Services
End
Recommended Action:
Recommended action
A) Authorize the Chair to execute the First Amendment to the Agreement for the Provision of Inmate Medical and Dental Services, with California Forensic Medical Group, Inc. (commonly known as Wellpath) to add California Advancing and Innovating Medi-Cal (CalAIM) Justice-Involved Reentry Initiative pre-release and reentry services, increasing the contract total to a not to exceed amount of $64,616,688, The agreement expires on October 21, 2026, unless parties exercise the options to extend the term through October 31st, 2028
B) Authorize the Chair to execute the Agreement for Medication Assisted Treatment Services with Wellpath for the period January 1, 2026, through December 31, 2028, for a total not to exceed amount of $2,801,636.
end
Executive Summary:
The Sheriff-Coroner is requesting execution of an amendment and agreement needed to implement services mandated by the State of California’s Department of Healthcare Services (DHCS) Cal-AIM Justice Involved Initiative (Cal-AIM JII). There are several components to Cal-AIM JII. This item will implement Cal-AIM pre-release and reentry services for an estimated annual cost of $837,026 and Medication Assisted Treatment (MAT) services, for an estimated cost of $888,703. The pre-release and reentry services overlap with the existing incarcerated person healthcare services currently provided by Wellpath. Therefore, the most efficient method to add these services was to amend the existing agreement. MAT services are being added under a separate agreement, as these services could potentially be administered by a separate vendor. As a result, the Sheriff’s Office issued a request for proposals process to select a MAT provider.
Discussion:
On January 26, 2023, California became the first state in the nation approved to offer a targeted set of Medicaid services to youth and eligible adults in state prisons, county jails, and youth correctional facilities for up to 90 days prior to release. This initiative is referred to as CalAIM Justice Involved Initiative (Cal-AIM JII). The CalAIM JII initiative includes a variety of provisions for justice-involved populations, aiming to provide enhanced care coordination and behavioral health services for individuals transitioning from incarceration to the community. Over the past year, the Board has approved actions needed to prepare for Cal-AIM JII.
Pre-Release and Reentry Services Amendment
The First Amendment to the Agreement for the Provision of Inmate Medical and Dental Services will add services needed to provide Cal-AIM JII required pre-release and reentry services for the incarcerated persons identified as eligible under Cal-AIM JII. Examples of these services include screening, developing a reentry care plan, completing assessments, providing medication for release, if applicable, coordinating care, and providing post-transition support. Sheriff’s managers have been participating in various Cal-AIM JII informational forums to determine how to best implement Cal-AIM JII. After reviewing information from DHCS, other Sheriff’s Office Adult Detention Divisions, county partners, and a Cal-AIM JII consultant, it was determined that the nature of the services overlap with the existing provision of healthcare services, allowing us to partner with Wellpath under our existing agreement.
The proposed amendment outlines the new services and additional resources required to implement the Cal-AIM JII, including the requirement to bill Medi-Cal for eligible services provided. These new services will require 4.2 additional employees and cost $837,036 per year.
The amendment to the contract will cost $1,604,709, for a new, not to exceed total of $64,616,688 through October 31, 2028, assuming a 5% CPI increase per year and also assuming parties exercise both options to extend the term for one additional year beyond the Agreement’s expiration date of October 31, 2026. Annual increases are based on the actual CPI. The proposed amendment adds staffing needed to perform the Cal-AIM JII pre-release and re-entry services added to the scope of work. The payment provision of the Original Agreement is being amended to add the additional costs related to the expanded scope of work. No other provisions of the Original Agreement are changing.
Medication Assisted Treatment (MAT) services
The CalAIM JII requires correctional facilities to provide Medication-Assisted Treatment (MAT) for opioid use disorder and other behavioral health needs to Cal-AIM eligible individuals, ensuring continuity of care through Medi-Cal enrollment and "warm handoffs" to community providers, prescribing medication, therapy and post-release support, including a 30-day supply of medication. The proposed Agreement adds contractor employees, pharmaceuticals, supplies and administrative expenses to provide the MAT services. Currently MAT “continuation” services (incarcerated persons participating in MAT prior to incarceration) allow treatment to continue while individuals are in custody. Under Cal-AIM provisions, MAT services will be expanded to include all eligible incarcerated persons. Unlike pre-release and reentry services, it is possible to have a separate provider administer MAT services. To fully vet this opportunity and to ensure the most competitive pricing was obtained, the Sheriff’s Office issued a request for proposal (RFP) for MAT services in April 2025. Three suppliers responded to the RFP and a six-member committee from the Sheriff’s Office, Health Services, and the Probation Division evaluated the proposals. The submissions were received from Wellpath, Wellness and Equity Alliance (WEA), and Santa Rosa Community Health Services (SRCH). The proposal from Wellpath Services received the highest ranking based on their experience, ability to provide the requested services, and program cost. Wellpath successfully demonstrated that they are the best-prepared supplier to provide the requested MAT services within the required Cal-AIM timeframes, compared to WEA or SRCH.
Under the proposed MAT Services Agreement, Wellpath Services will provide 4.15 full-time equivalent (FTE) positions to staff the expanded MAT program, including 1.0 FTE Registered Nurse (RN) MAT Coordinator, 1.40 FTE Licensed Vocational Nurse (LVN), 0.60 Nurse Practitioner/Physician Assistant (NP/PA), 0.75 FTE MAT Substance Abuse Counselor, and 0.40 FTE MAT Discharge Planner. The proposed agreement includes the provisions outlined in the RFP for a three-year term. The estimated cost of the agreement is $888,703 for Year 1; $933,138 for Year 2, which assumes a 5% COLA (actual annual COLAs are based on the CPI); and $979,795 for Year 3, also including a 5% COLA; for a total not to exceed amount of $2,801,636 through the ending term date of December 31, 2028.
Both the Amendment and the Agreement are in the final stages of being approved by both parties. Drafts of both documents are attached; however, there may be minor modifications to the drafts. Any subsequent changes will not change the staffing levels, costs, or term and will be approved by County Counsel prior to the Chair executing the final documents.
Funding
As part of the Cal-AIM JII, 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 Cal-AIM justice-involved reentry services. Funding may be used to support investments in personnel, capacity, and/or IT systems necessary for collaborative planning and the structural improvements required to implement Cal-AIM 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 services were included in the Sheriff’s Office FY 25-26 Adopted Budget. The Sheriff’s Office has an approved PATH 3 expenditure plan that will fund the services outlined in the proposed Amendment and MAT Services Agreement through September 2026. Over the next nine months, the goal is to implement the services and establish related Medi-Cal billing procedures, ensuring that Medi-Cal will continue funding these services after the grant funds are expended.
Strategic Plan:
N/A
Racial Equity:
Was this item identified as an opportunity to apply the Racial Equity Toolkit?
No
Prior Board Actions:
02/04/25 - The Board adopted position resolutions to add 3.0 Cal-AIM Justice involved support positions.
1/30/24 - Approval of Grant Funding for Medi-Cal Expansion to the Justice-Involved Population
10/26/21 - The Board approved the Inmate Medical and Dental Agreement with Wellpath
Fiscal Summary
|
Expenditures |
FY25-26 Adopted |
FY26-27 Projected |
FY27-28 Projected |
|
Budgeted Expenses |
$862,870 |
$1,812,026 |
$1,902,627 |
|
Additional Appropriation Requested |
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Total Expenditures |
$862,870 |
$1,812,026 |
$1,902,627 |
|
Funding Sources |
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General Fund/WA GF |
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State/Federal |
$862,870 |
$1,812,026 |
$1,812,026 |
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Fees/Other |
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Use of Fund Balance |
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General Fund Contingencies |
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Total Sources |
$862,870 |
$1,812,026 |
$1,902,627 |
Narrative Explanation of Fiscal Impacts:
The figures in the table above represent approximately six months of costs for Cal-AIM JII pre-release and reentry services, as well as MAT services for FY 25-26 (January through June 2026). Costs for FY 26-27 and FY 27-28 assume a 5% increase. The Sheriff’s Office has an approved PATH 3 expenditure plan that will fund the services through at least September 2026. Over the next nine months, the goal is to implement Cal-AIM JII services and establish related Medi-Cal billing procedures, ensuring that Medi-Cal will continue funding these services once the grant funds are expended.
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Staffing Impacts: |
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Position Title (Payroll Classification) |
Monthly Salary Range (A-I Step) |
Additions (Number) |
Deletions (Number) |
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Narrative Explanation of Staffing Impacts (If Required):
N/A
Attachments:
1. First Amendment to the Agreement for the Provision of Inmate Medical and Dental Services
2. Medication Assisted Treatment (MAT) Services Agreement for Incarcerated Adults
Related Items “On File” with the Clerk of the Board:
N/A