To: Board of Supervisors
Department or Agency Name(s): Sheriff’s Office, County Administrator’s Office, Human Services, Probation, Health Services
Staff Name and Phone Number: Sharon Post, 565-1119
Vote Requirement: Majority
Supervisorial District(s): Countywide
Title:
Title
Agreements for FY 2023-26 Medi-Cal County Inmate Program
End
Recommended Action:
Recommended action
A) Authorize the County Administrator to sign the following documents related to the Medi-Cal County Inmate Program which allow the County to continue participating in the Medi-Cal County Inmate Program and receive federal funding to cover a share of inpatient medical care costs for eligible Sonoma County incarcerated persons:
i. Agreement with the State Department of Health Care Services for continued participation in the Medi-Cal County Inmate Program for the term starting July 1, 2023. The Agreement will remain in effect until terminated by either party.
ii. Agreement to reimburse the State Department of Health Care Services for administrative costs associated with the Medi-Cal County Inmate Program, for the term July 1, 2023 through June 30, 2026, for a not-to- exceed amount of $17,082.
iii. Any additional forms or documents required for participation in the Medi-Cal County Inmate Program from the initial date of April 1, 2016 through June 30, 2026, provided that any such documents are approved by County Counsel and consistent with the provisions of the approved participation and administrative Agreements.
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Executive Summary:
Approval of the proposed agreements will allow Sonoma County to continue participating in the Medi-Cal County Inmate Program (“Program”) to utilize funding from Medi-Cal to cover the federal share of inpatient medical care costs for incarcerated persons who are eligible for Medi-Cal. Through this Program, the State will pay approved claims directly to the hospitals providing services to incarcerated persons. In the event the State pays for any costs not covered by federal funding, the proposed agreement requires the County to reimburse the State for the non-federal share of these claims. The Agreement also includes State administrative costs averaging $5,700 per year from July 1, 2023 through June 30, 2026. This Program will cover both adult and juvenile offenders in the custody of the County.
Discussion:
Prior to implementation of the Medi-Cal County Inmate Program, the County General Fund covered the full cost of medical care for individuals incarcerated in either the County’s adult or juvenile detention facilities. The approval of three different pieces of legislation created what is now collectively known as the Medi-Cal County Inmate Program. AB 1628 in 2010 established the Adult County Inmate Program; SB 695 in 2011 established the Juvenile County Ward Program; and SB 1462 in 2012 established the County Compassionate Release Program. Since passage of these laws, the State Department of Health Care Services has established the administrative oversight to implement these programs, which allow the claiming of the federal share of Medi-Cal funds for inpatient hospitalizations for these specific populations.
Health care services are currently provided in the adult detention facilities through a contract with California Forensic Medical Group (CFMG)/Wellpath, and in the juvenile facilities through a contract with the County Department of Health Services. Prior to creation of the Medi-Cal County Inmate Program, the County was responsible for the cost of hospitalizations of incarcerated persons. With the implementation of the Program in April 2016, the providing hospitals now bill Medi-Cal directly for services provided to eligible incarcerated persons, and Medi-Cal pays the provider at the approved rate. On a quarterly basis, the State Department of Health Care Services bills the County for the non-federal share of these claims.
Implementation of the Program in the adult detention facilities requires intensive, ongoing coordination between CFMG/Wellpath staff, an enrollment counselor contracted through Redwood Community Health Coalition (RCHC, recently renamed Aliados Health), the hospitals, the County’s Human Services Department (responsible for submitting Medi-Cal applications to the State), and the State Department of Health Care Services. The CFMG/Wellpath and RCHC Agreements comply with the regulations of the Program.
In FY 2017-18, the Program was still being rolled out and a full year of activity did not occur. In FY 2018-19, the County’s costs to participate in this Program included State Department of Health Care Services administrative fees ($4,545), and the cost of the Redwood Community Health Coalition contract ($37,756). In FY 2018-19, the County realized over $750,000 in savings by participating in the Program. These savings covered the costs of the enrollment counselor and program administrative fees. The County’s portion of non-federal costs was approximately $100,000; however, these costs would have been the County’s responsibility regardless of MCIP participation. With lower jail population due to the pandemic, the non-federal share was $65,430 in FY 19-20, $65,541 in FY 20-21, and $58,429 in FY 21-22. The non-federal costs will continue to vary from year to year as these costs are based on the specific services provided to incarcerated persons. With the exception of RCHC’s staff, the Sheriff’s Office, Probation, and Human Services Department are absorbing the workload related to MCIP. Staff recommends entering into these proposed agreements to allow for continued participation in the Program.
Strategic Plan:
N/A
Prior Board Actions:
8/4/20 - Board approved the FY 2021-23 Medi-Cal County Inmate Program Agreements
10/8/19 - Board approved the FY 2019-20 Medi-Cal County Inmate Program Agreement
6/12/18 - Board approved the FY 2018-19 Medi-Cal County Inmate Program Agreement
2/7/17 - Board approved the Medi-Cal County Inmate Program Agreement for April 1, 2016 - June 30, 2018
Fiscal Summary
|
Expenditures |
FY 22-23 Adopted |
FY23-24 Projected |
FY 24-25 Projected |
|
Budgeted Expenses |
$120,257 |
$129,881 |
$140,271 |
|
Additional Appropriation Requested |
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Total Expenditures |
$120,257 |
$129,881 |
$140,271 |
|
Funding Sources |
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General Fund/WA GF |
$120,257 |
$129,881 |
$140,271 |
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State/Federal |
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Fees/Other |
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Use of Fund Balance |
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Contingencies |
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Total Sources |
$120,257 |
$129,881 |
$140,271 |
Narrative Explanation of Fiscal Impacts:
The Sheriff’s Office FY 22-23 Adopted Budget includes $120,257 to cover Program costs, including: $50,000 for the Redwood Community Health Coalition enrollment counselor contract; $5,257 for the MCIP Administrative fees paid to the State; and $65,000 for the County’s estimated MCIP share of non-federal costs. Future year estimated costs for the RCHC/Aliados Health contract and share of non-federal costs are estimated to increase due to inflation and potential growth in jail population and Medi-Cal enrollments. The County’s total cost for Medi-Cal County Inmate Program Administrative Services shall not exceed the following annual amounts per the Agreement: $5,262 for the first year; $5,683 for the second year; and $6,137 for the third year. The estimated cost avoidance that will be realized from participating in the Program is incorporated into the Sheriff’s Office FY 23-24 Requested Budget as reduced expenditures. The Sheriff’s Office is able to cover aforementioned costs for the enrollment counselor, program administrative fees, and non-federal share using General Fund monies that were historically allocated to cover catastrophic medical costs prior to MCIP implementation.
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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:
Medi-Cal County Inmate Program Participation Agreement for FY 23-26
Medi-Cal County Inmate Program Agreement for Administrative Services for FY 23-26
Related Items “On File” with the Clerk of the Board:
N/A