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 Grant
End
Recommended Action:
Recommended action
Approve 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.
end
Executive Summary:
California State County Medical Services Program Governing Board recently issued a letter to local health care systems announcing the availability of grant funding for projects that expand the delivery of locally directed indigent care services for low-income, uninsured, and under-insured adults that lack access to health care, behavioral health services, and associated support services. The Department of Health Services is eligible to request $1,500,000 of this grant funding ($500,000 per year over 3 years). Board of Supervisors support, as requested in this report, is required for submission of the grant application.
Under the grant program, applicants may seek implementation program grants of up to $500,000 per year for up to three years in order to accomplish the following: 1) promote timely delivery of necessary medical and behavioral health services and support services to locally identified target populations, 2) link populations to other community resources and support, and 3) improve overall health outcomes for these target populations.
The Department intends to request $1,500,000 to support the enhanced coordination of care and provision of supportive housing services for some of the County’s most vulnerable inhabitants. This use is consistent with the grant goals. The grant will be used to fund approximately 10 permanent supportive housing beds for homeless individuals with medical, behavioral health, and/or substance use disorder challenges being discharged from the County’s Adult Detention Center and local acute care facilities. It will also fund a community-wide Discharge Planner to ensure efficient continuity of care planning for homeless residents and other indigent high-needs residents who are being discharged from inpatient care and treatment but remain medically and/or behaviorally vulnerable. This position will work closely with County and community service partners 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. The need for such a position surfaced in a countywide discharge planning and coordination meeting on October 24, 2019 attended by over 60 participants from local hospitals, federally qualified health care centers, substance use disorder treatment centers, law enforcement agencies, behavioral health providers, and housing providers. The grant application is due to the California State County Medical Services Program Governing Board on December 20, 2019.
Awardees are required to provide in-kind and/or matching funds in the amount of no less than ten percent of the implementation grant program amount per year. Prior Board actions on similar grant applications have included staff support and project management as in-kind support provided by participating Safety Net Departments.
Discussion:
California State County Medical Services Program Governing Board recently issued a letter to local health care systems announcing the availability of grant funding for projects that expand the delivery of locally directed indigent care services for low-income, uninsured and under-insured adults that lack access to health care, behavioral health services, and associated support services. The Department of Health Services is eligible to request $1,500,000 of this grant funding. Board of Supervisors support, as requested in this report, is required for submission of the grant application.
Under the grant program, applicants may seek implementation program grants of up to $500,000 per year for up to three years in order to accomplish the following: 1) promote timely delivery of necessary medical and behavioral health services and support services to locally identified target populations, 2) link populations to other community resources and support, and 3) improve overall health outcomes for these target populations.
The Department of Health Services intends to request $1,500,000 to support the enhanced coordination of care and provision of supportive housing services for some of the County’s most vulnerable inhabitants. Specifically, the grant will fund:
- A contract with an experienced community based organization to provide approximately 10 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 (Health Program Manager) 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.
The County Medical Services Program Grant Request for Proposals (application) allows the applicant to target homeless adults for the provision of services. As such, all of the 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 this grant will be to prevent those individuals who are homeless at the time of inpatient discharge from returning to homelessness and 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.
Awardees are required to provide in-kind and/or matching funds in the amount of no less than ten percent of the implementation grant program amount per year. Prior Board actions on similar grant applications have included staff support and project management as in-kind support provided by participating Safety Net Departments.
A separate Board item from the Probation Department requests approval of a services agreement with a community partner to provide supportive housing and case management for defendants who are homeless and have mental illness. The Probation Department’s program provides supervised temporary housing to incarcerated defendants who are awaiting trial and would otherwise remain in a detention facility until adjudication because of their mental health and living conditions. With implementation of the Health Services’ program, the departments will collaborate to streamline program navigation for clients as they are released from jail and, as appropriate, transition Probation Department clients into permanent housing supported by the Health Services program.
Prior Board Actions:
On February 26, 2019 the Board approved submission of a grant application to the California State County Medical Services Program Governing Board requesting $300,000 to develop and implement strategies to improve delivery of health care services to current and potential County Medical Services Program members.
Fiscal Summary
|
Expenditures |
FY 19-20 Adopted |
FY 20-21 Projected |
FY 21-22 Projected |
|
Budgeted Expenses |
|
500,000 |
500,000 |
|
Additional Appropriation Requested |
250,000 |
|
|
|
Total Expenditures |
250,000 |
500,000 |
500,000 |
|
Funding Sources |
|
|
|
|
General Fund/WA GF |
|
|
|
|
State/Federal (CMSP) |
250,000 |
500,000 |
500,000 |
|
Fees/Other |
|
|
|
|
Use of Fund Balance |
|
|
|
|
Contingencies |
|
|
|
|
Total Sources |
250,000 |
500,000 |
500,000 |
Narrative Explanation of Fiscal Impacts:
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 2019-2020 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 funding will be received as follows: FY 19-20 - $250,000; FY 20-21 - $500,000; FY 21-22 - $500,000; and FY 22-23 - $250,000.
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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:
None
Related Items “On File” with the Clerk of the Board:
None