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Receive a presentation and affirm the submission on the CalAIM Initiative including the Sheriff’s Office Implementation Plan and Budget required by the California Department of Health Care Services (DHCS) to provide 90-Day Pre-Release Medi-Cal services to Solano County’s justice-involved persons within the County jails; Delegate authority to the County Administrator to approve the Implementation Plan and Budget including any subsequent technical adjustments or amendments; Adopt a resolution amending the List of Numbers and Classification of Positions to add 1.0 FTE Project Manager (Limited-Term) in the Inmate Programming Division of the Sheriff’s Office; and Approve two Appropriation Transfer Requests totaling $572,564 recognizing unanticipated revenue offset by grant related expenditures in both the Sheriff’s Office budget and the CalAIM PATH-JI Round 3 budget (4/5 vote required)
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Published Notice Required? Yes ____ No _X _
Public Hearing Required? Yes ____ No _X _
DEPARTMENTAL RECOMMENDATION:
The Sheriff recommends that the Board of Supervisors:
1. Receive a presentation and affirm the submission on the CalAIM Initiative including the Sheriff’s Office Implementation Plan and Budget required by the California Department of Health Care Services (DHCS) to provide 90-Day Pre-Release Medi-Cal services to Solano County’s justice-involved persons within the County jails;
2. Delegate authority to the County Administrator to approve the Implementation Plan and Budget including subsequent technical adjustments or amendments;
3. Adopt a resolution amending the List of Numbers and Classification of Positions to add 1.0 FTE Project Manager (Limited-Term) in the Inmate Programming Division of the Sheriff’s Office; and
4. Approve two Appropriation Transfer Requests totaling $572,564 recognizing unanticipated revenue offset by grant related expenditures in both the Sheriff’s Office budget and the CalAIM PATH-JI Round 3 budget (4/5 vote required).
SUMMARY:
Under the California Advancing and Innovating Medi-Cal (CalAIM), correctional facilities are required to go-live with 90-Day Pre-Release Medi-Cal services by October 1, 2026. On October 24, 2023, the Board of Supervisors affirmed the submission of a grant application to the California Department of Health Care Services (DHCS) for the Providing Access and Transforming Health Justice-Involved (PATH-JI) Reentry Initiative Capacity Building Program - Round 3 to support the planning and implementation of the provision of targeted pre-release Medi-Cal services to individuals in state prisons, county jails, and youth correctional facilities. PATH-JI Round 3 requires a readiness assessment and the creation of an implementation plan and budget to support readiness activities.
The Sheriff’s Office submitted the Implementation Plan (Attachment A) and Budget (Attachment B) to DHCS on April 30, 2024, and has received DHCS approval. The Sheriff’s Office will present an overview of the CalAIM Initiative and the Sheriff’s Office Implementation Plan and Budget to the Board and is requesting the Board affirm the submission and DHCS’ approval of the Implementation Plan and Budget. Additionally, the Sheriff’s Office has been working with Human Resources to add a Project Manager (Limited-Term) to the Inmate Programming Division of the Sheriff's Office to act as the CalAIM coordinator, to assist the Sheriff Criminal Justice Program Services Manager, who is acting as the CalAIM manager, in collecting, monitoring, and reporting on DHCS required measures and to provide compliance oversight; therefore, it is recommended that the Board adopt a resolution amending the List of Numbers and Classification of Positions to add this position.
FINANCIAL IMPACT:
Board action will have no impact to the County General Fund. The PATH-JI Round 3 grant award is $3,500,000 and is delineated in the program budget (Attachment B). The Sheriff’s Office has already received $2,450,000 in advance funding with a current remaining balance of $2,235,555. The estimated FY2024/25 cost is $710,250 as the Sheriff’s Office anticipates continuing costs for the consultant, IT services, and salary and benefits for the addition of the Project Manager (Limited-Term) position. The annualized cost for the position is approximately $169,312; however, the estimated FY2024/25 cost is $42,264 as the position is anticipated to be filled on March 31, 2025.
The FY2024/25 PATH-JI Round 3 and Sheriff’s operating budgets do not currently have sufficient appropriations; therefore, an Appropriation Transfer Request (ATR) of $530,300 is needed in the PATH-JI Round 3 budget to recognize grant revenue offset by an increase in appropriations for contracted services and to transfer funds in the amount of $42,264 to the Sheriff’s operating budget for the cost of the Project Manager (Limited-Term) position. A second ATR will recognize that transfer, offset by salary and benefits is required.
The costs associated with preparing the agenda item are nominal and absorbed by the department’s FY2024/25 Working Budget.
DISCUSSION:
California statute (AB 133 Chapter 143, Statutes of 2021) established CalAIM which mandates all counties begin implementation of pre-release Medi-Cal enrollment processes for justice-involved adults and youth. DHCS issued a series of grants to assist with the implementation.
Solano County applied for the DHCS CalAIM Providing Access and Transforming Health Justice-Involved (PATH-JI) Round 1 planning grant in July 2022 to support collaborative planning between county correctional agencies, H&SS, and other enrollment implementation partners. An allocation of $125,000 was awarded to the Sheriff’s Office on August 12, 2022.
A CalAIM PATH-JI Round 2 implementation grant joint application by H&SS, Sheriff’s Office, and Probation Department was submitted on March 29, 2023. The Board of Supervisors accepted a total of $1,623,083 in Round 2 implementation grant funds on June 27, 2023, with DHCS allocating $449,908 to H&SS and $1,173,175 to the Sheriff’s Office. This implementation grant allows H&SS, Sheriff’s Office, and the Probation Department to implement processes, protocols, and information technology system modifications necessary to comply with pre-release Medi-Cal enrollment and suspension mandates in accordance with AB 133, including establishing data sharing automation between the Sheriff’s Office and H&SS’ Employment and Eligibility Division computer systems, create sound business process design and process management to become fully compliant.
The Sheriff’s Office applied for the CalAIM PATH-JI Round 3 grant on July 31, 2023, and was awarded $3,500,000 to conduct a readiness assessment, develop an implementation plan and budget, and implement Medi-Cal services. The Sheriff’s Office contracted with Health Management Associates (HMA) to assess the Sheriff’s 90-day pre-release readiness and assist in developing the Implementation Plan and Budget. Readiness assessments for correctional agencies address whether correctional facilities are able to go live to provide 90-day Medi-Cal Reentry Services and screening/referrals for behavioral health links across their respective facilities. HMA met with the Sheriff’s Office and other County stakeholders to develop the Implementation Plan and Budget. The Implementation Plan addresses the required areas of focus: 90-Day Pre-Release Eligibility Screening, 90-Day Pre-Release Service Delivery, Reentry Planning and Coordination, and Oversight and Project Management, and the corresponding readiness elements. The Budget is summarized below.
Technology and Data Sharing: $1,700,000 to enhance existing provider Electronic Health Records Systems in order to bill Medi-Cal, to develop secure data exchanges with the Sheriff’s Jail Management System, other County departments, Managed Care Plans, other providers and state agencies; and to create a billing system for tracking and reconciling Medi-Cal reimbursement revenues, including contracting with a Third-Party Administrator (TPA).
Staffing Structure and Plan: $969,822 to fund consulting services to conduct a readiness assessment and assist with the development of the implementation plan and budget and the implementation of Medi-Cal services; and to fund a Project Manager (Limited-Term) position to act as the CalAIM coordinator. This position will assist the Sheriff Criminal Justice Program Services Manager, who is acting as the CalAIM manager, collect, monitor, and report on DHCS required measures and to provide compliance oversight. The Limited-Term position will be funded through March 31, 2027, after which, it is anticipated that Medi-Cal reimbursement revenue will offset any necessary consulting services and salary and benefits costs.
Support of Pre-Release Care Management: $452,220 to expand existing contracts for case management reentry services and pre-release services. The additional funding will be included in contracts through March 31, 2027, after which, Medi-Cal reimbursement revenue is expected to offset contracted services costs.
Support for Medicated Assisted Treatment (MAT): $226,043 to expand existing contracts for MAT services to meet capacity needs and comply with MAT requirements. This will allow the current vendor to hire additional staff through March 31, 2027, after which, Medi-Cal reimbursement revenue is expected to offset the increased contracted services.
Virtual In-Person In-Reach Provider Support: $151,915 to fund a full-time Correctional Officer position responsible for escorting justice-involved persons to and from in-person meeting rooms and video visitation stations. Current staffing levels are being evaluated to determine if a current allocated Correctional Officer can provide these services. The position will be funded through March 31, 2027, after which, Medi-Cal reimbursement revenue is expected to offset salary and benefits costs.
The Sheriff’s Office will continue to refine the Implementation Plan and budget as needed to meet changing state requirements and/or guidance including technical adjustments.
ALTERNATIVES:
The Board could choose not to receive this report and/or affirm the Implementation Plan and Budget; however, this alternative is not recommended as correctional facilities are mandated to implement 90-Day Pre-Release Medi-Cal services by October 1, 2026. Moreover, approval of the added limited-term position and the Appropriations Transfer Requests are contingent upon affirmation of the Implementation Plan Budget.
OTHER AGENCY INVOLVEMENT:
The Sheriff’s Office and HMA consulted with DoIT, H&SS, and other stakeholders to create the Implementation Plan. HMA assisted with preparing this presentation. Human Resources has reviewed and approved the classification and has prepared the resolution to amend List of Numbers and Classification of Positions.
CAO RECOMMENDATION:
APPROVE DEPARTMENTAL RECOMMENDATION