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Approve a revised Intergovernmental Transfer to the State of California in the amount of $4,433,339 for mental health services for Medi-Cal clients; Authorize the County Administrator to execute the necessary agreements with the State of California and Partnership HealthPlan of California and any related documents; and Approve an Appropriation Transfer Request (ATR) for additional increase in appropriations for FY2011/12 in the amount of $532,001 representing a $443,334 additional IGT plus an increase in State administrative fee of $88,667 and recognize an increase of $532,001 in unanticipated Federal Revenue in FY2011/12 (4/5 vote required)
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Published Notice Required? Yes ____ No __X_
Public Hearing Required? Yes ____ No __X_
DEPARTMENTAL RECOMMENDATION:
The Department of Health and Social Services (H&SS) recommends the Board:
1) Approve a revised Intergovernmental Transfer (IGT) to the State of California in the amount of $4,433,339 for mental health services;
2) Authorize the County Administrator to execute the necessary agreements with the State of California and Partnership HealthPlan of California (PHC) and any related documents;
3) Approve an Appropriation Transfer Request (ATR) to increase appropriations for FY2011/12 in the amount of $532,001 representing an increase in IGT of $443,334 plus an increase in State administrative fee of $88,667 and recognize an increase of $532,001 in unanticipated Federal Revenue in FY2011/12 (4/5 vote required).
SUMMARY/DISCUSSION:
On March 13, 2012, the Board approved an IGT, authorizing the transfer of $3,990,005 to the California Department of Health Services (CDHS), allowing the County to draw down additional Federal funds. In addition to the IGT funds of $3,990,005, the Board also authorized the payment of a State administrative fee of twenty percent ($798,001). Under the proposed agreement, the County would receive $10,269,477 in unanticipated Federal funds, for a net increase in revenue of $5,481,471.
Subsequently, H&SS was notified by the DHCS that the County may increase the amount of the IGT up to $4.4 million. Under the revised agreement, the County would transfer $4,433,339 in unmatched County General Fund (CGF) and Mental Health Services Act (MHSA) plus the twenty percent State administrative fee of $886,668. The County would receive approximately $11.4 million in unanticipated Federal funds, a net gain of $6,090,524 which is approximately $609,053 more than anticipated under the original IGT amount.
The State will approve the IGT retroactively from July 2011 through June 2012 and submit the agreement to the Center for Medicaid and Medicare Services (CMS) for federal approval. All of the funds associated with the IGT must be used for the provision of mental health services to Medi-Cal beneficiaries.
As indicated in the March 13, 2012, IGT agenda item, H&SS has utilized the funds for integration of mental health services and primary care services in the County's Family Health Services clinics, as well as two community clinics, La Clinica and Community Medical Centers. Funding has also been dedicated to restore case management services, provide psychiatric consultations to physicians in the community, and to train primary care providers and other health care professionals on mental health conditions. In addition, a portion of the IGT funds will be used to operate the Crisis Stabilization Unit (CSU), which was identified, as a high priority unmet need by the Mental Health Task Force. The CSU will be located at the H&SS campus in Fairfield, and will provide crisis intervention services, and reduce the number of admissions to acute psychiatric hospitals. H&SS will continue to work with the PHC, healthcare providers, community and former task force members, as well as consumers and their families to improve and stabilize mental health services.
FINANCIAL IMPACT:
The Department currently utilizes a combination of local funds, including CGF, Realignment, and MHSA funds to match approximately $14 million in Federal Medicaid funds for mental health services. Solano County also receives approximately $8.5 million in MHSA funds annually as a result of Proposition 63, which increased taxes on incomes exceeding $1 million.
The IGT approved on March 13, 2012, would have allowed the County to realize an additional $10.3 in Federal funding, for a net gain of $5,481,471. The revised IGT will provide an opportunity for the County to utilize $4.4 million in otherwise unmatched MHSA and CGF toward the receipt of $11.4 million in additional Federal Medicaid funds, a net gain of $6,090,524. Approval of the ATR will allow the Department to transfer $4,433,339 in CGF and MHSA funds to the CDHS, along with a State administrative fee of $886,668 for a total expenditure of $5,320,007. The resulting net gain of $6,090,524 is approximately $609,053 more than anticipated under the original IGT. The IGT funds may be utilized over a period of several years, which will allow the Department to maintain service levels and mitigate the impact of the decreases in CGF and Realignment funding for the next 2-3 year period. There is no additional impact on the CGF.
ALTERNATIVES:
The Board may choose to not authorize the IGT. This is not recommended because doing so would have no impact on CGF expenditures, while foregoing a net increase of $6.09 million in Federal funding. Declining to pursue this Federal funding would hamper the Department's efforts to better meet the County's near-term mental health and related public safety needs and mitigate the loss of CGF and reduction in State Realignment funds in the past several years.
OTHER AGENCY INVOLVEMENT:
The CDHS has included the IGT funding for Solano County in the State's FY2010/11 budget. The PHC's Board of Directors has approved participation in the IGT.
CAO RECOMMENDATION:
APPROVE DEPARTMENT RECOMMENDATION