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Approve casting Solano County’s vote for Supervisor Cassandra James in the County Medical Services Program Governing Board Group 3 County Supervisor runoff election; and Authorize the Chair to execute and submit the official ballot
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Published Notice Required? Yes ___ No _x_
Public Hearing Required? Yes ___ No _x_
DEPARTMENTAL RECOMMENDATION:
The County Administrator’s Office recommends the Board of Supervisors approve casting Solano County’s vote for Supervisor Cassandra James in the County Medical Services Program Governing Board Group 3 County Supervisor runoff election; and Authorize the Chair to execute and submit the official ballot.
SUMMARY:
The County Medical Services Program (CMSP) was established in 1983 to provide healthcare coverage for low-income adults in California’s smaller counties. Today, CMSP serves 35 participating counties and continues to provide coverage for eligible uninsured residents as changes to Medi-Cal eligibility and funding occur. The CMSP Governing Board, established in 1995, provides overall program and fiscal oversight and consists of ten elected county officials representing participating counties and one non-voting state representative.
Supervisor John Vasquez joined the CMSP Governing Board in May 2023 and has since stepped down, creating a vacancy for the remainder of the term ending December 31, 2027. The replacement must be a current County Supervisor from a participating CMSP county and, because this is the Group 3 Supervisor seat, must come from Marin, Napa, Solano, or Sonoma County. With Marin and Napa counties already represented on the Governing Board, only Solano or Sonoma County may nominate a candidate for the vacant seat.
At its July 28, 2026, meeting, the Board considered the nomination of a Solano County representative to the CMSP Governing Board and supported the nomination of District 1 Supervisor Cassandra James as Solano County’s candidate for the Group 3 County Supervisor representative seat. The Board also authorized the County Administrator’s Office to submit the nomination to CMSP.
On August 31, 2026, the County received notification from Shaw Yoder Antwih Schmelzer & Lange (SYASL Partners) that the initial Group 3 County Supervisor election resulted in a tie between Supervisor James and Sonoma County Supervisor Chris Coursey. CMSP has therefore directed that a runoff election be conducted between the same two candidates, with each Group 3 county required to submit a new ballot by September 30, 2026. Solano County must therefore take action to cast its vote in the runoff election.
FINANCIAL IMPACT:
Nomination of a representative has no direct fiscal impact. However, the CMSP Governing Board is responsible for maintaining the fiscal soundness of the CMSP benefit program and the overall CMSP budget, which will have future impacts on Solano County.
DISCUSSION:
The County Medical Services Program (CMSP) was established in 1983, when California law eliminated certain low-income adults from Medi-Cal and transferred responsibility for their health care to California counties. Recognizing that many smaller and rural counties were not positioned to independently assume this responsibility, the State provided counties with populations of 300,000 or fewer the option of contracting with the State to provide these health care services through CMSP. The State Department of Health Services utilized the administrative infrastructure of Medi-Cal’s fee-for-service program to administer CMSP.
1991 Realignment revenue historically served as the primary revenue source supporting CMSP. In 2013, implementation of the Affordable Care Act (ACA) expanded Medi-Cal eligibility to include many low-income uninsured adults, and Realignment funding was substantially revised under AB 85, redirecting much of the revenue previously dedicated to indigent health care to the State. Counties participating in CMSP retained a portion of this funding to continue providing health care services to eligible uninsured residents who remain outside Medi-Cal coverage. With current federal program changes under H.R. 1 and additional State changes affecting Medi-Cal eligibility and coverage, CMSP is expected to play a critical role in providing health care coverage to eligible uninsured residents in participating counties.
The CMSP Governing Board was established by California law in April 1995 and has overall program and fiscal responsibility for CMSP. Under the authorities set forth in Welfare and Institutions Code section 16809, the Governing Board is responsible for establishing program eligibility standards, defining the scope of covered health care benefits, and determining payment rates for health care providers delivering emergency and non-emergency services to CMSP members.
The Governing Board is composed of 11 members. Ten members are county officials elected or selected by the 35 participating CMSP counties, including three County Supervisors, three County Administrative Officers, two County Health Officials and two County Welfare Directors. The eleventh member is an ex-officio, non-voting representative of the California Health and Human Services Agency. The Governing Board generally meets six times per year.
To serve as a voting member of the CMSP Governing Board, an individual must hold office or employment in a participating CMSP county and serve in one of the designated county leadership positions represented on the Governing Board. County Supervisor representatives are elected by the Boards of Supervisors of the participating counties, while the other designated county officials are elected or selected by their respective peers. Voting members serve three-year terms and no two voting members may concurrently represent the same county.
The individual filling the current vacancy must also represent the same Governing Board County Group as the previous member. Solano County is part of Governing Board Group 3, which consists of Marin, Napa, Solano and Sonoma counties. Because Marin and Napa counties are already represented on the Governing Board, the eligible candidates for the vacant Group 3 County Supervisor seat are from Solano and Sonoma counties.
At its July 28, 2026, meeting, the Solano County Board of Supervisors considered the vacancy and supported the nomination of District 1 Supervisor Cassandra James as Solano County’s candidate for the Group 3 County Supervisor representative seat. The Board also authorized the County Administrator’s Office to submit the nomination to CMSP. Supervisor James discussed her professional experience in public health and Medi-Cal eligibility, as well as her work addressing potential impacts associated with H.R. 1.
Following the nomination process, Supervisor James and Sonoma County Supervisor Chris Coursey were placed before the Group 3 counties for consideration. On August 31, 2026, the County received notification from SYASL Partners that the initial election resulted in a tie between the two candidates. CMSP has therefore directed that a runoff election be conducted between Supervisor James and Supervisor Coursey. Each Group 3 county is required to submit a new ballot, with completed ballots due no later than September 30, 2026. CMSP has requested that participating counties have the matter considered by their respective Boards of Supervisors no later than September 29, 2026.
Staff recommends that the Board cast Solano County’s vote for Supervisor Cassandra James in the CMSP Governing Board Group 3 County Supervisor runoff election and authorize the Chair to execute and submit the official ballot.
ALTERNATIVES:
The Board may choose not to nominate Supervisor James; however, this is not recommended as the nomination provides an opportunity to have representation from Solano County on the CMSP Governing Board.
OTHER AGENCY INVOLVEMENT:
None.
CAO RECOMMENDATION:
APPROVE DEPARTMENTAL RECOMMENDATION