TO: Board of Supervisors
FROM: Alexander Alarcón, Director of Corrections
REPORT BY: John Buzolich, Special Assignment
SUBJECT: Amendment No. 5 to Agreement 190201B with Wellpath LLC
RECOMMENDATION
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Approve Amendment No. 5 to Agreement 190201B with California Forensic Medical Group, Inc., doing business as Wellpath LLC to extend the term to June 30, 2027, add the California Advancing and Innovating Medi-Cal (CalAIM) Justice-Involved Initiative services to provide health care services to incarcerated persons in custody at the Department of Corrections and youth housed at Probation’s Juvenile Hall and Skyline Academy, and a related Budget Amendment. (Fiscal Impact: $985,600 Expense; General Fund; Not Budgeted; Mandatory)
[4/5 vote required]
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BACKGROUND
Napa County entered into Agreement No. 190201B with California Forensic Medical Group, Inc., dba Wellpath LLC, on December 18, 2018, to provide specialized medical services. Amendment No. 1, approved in 2020, modified the payment schedule from quarterly to monthly. Amendment No. 2, approved in 2022, increased compensation to support recruitment and retention of qualified medical staff. Amendment No. 3, approved in 2025, increased compensation and added 5.925 Full Time Equivalent (FTE) medical staff positions to support operational needs and compliance with AB 268 requiring new standards of care for incarcerated people with mental health issues. Amendment No. 4, approved on July 1, 2026, extended the agreement for six months on a month-to-month basis.
To comply with State law to implement the CalAim Justice-Involved Reentry Initiative by October 1, 2026, this Amendment provides for mandatory health care services and targeted Medi-Cal services. County jails and youth detention facilities are required to provide targeted Medi-Cal services and care coordination up to 90 days before an individual’s release. The goal is to provide continuity of care so individuals leaving the jail or youth detention facility leave with active medical coverage and a warm handoff to community providers.
The Amendment adds 4.70 FTE to Wellpath’s medical staff, billing services paid at eight percent (8%) of the successfully collected Medi-Cal reimbursement, and uninterrupted medical services and operational continuity until the County issues a Request for Proposals (RFP) for health care and Medi-Cal services.
Both Corrections and Probation have budgeted for detention center medical services however these allocations did not fully account for all CalAIM related costs. Because these services are entirely new, the exact expenses required to successfully secure Medi-Cal reimbursements remain unknown. Following the mid-year (6-month) budget review, both departments will evaluate actual expenditures and revenue to determine if any incremental costs can be absorbed within existing appropriations or if a budget adjustment is required. However, the Department of Corrections is requesting additional appropriations at this time for the increase in the Amendment.
It is anticipated there will be some revenue offset by a State administered grant, Providing Access and Transforming Health (PATH 3), awarded to the Corrections and Probation department to support implementation costs and expanded services, in addition to Medi-Cal claim reimbursement. With new health services to be provided to Medi-Cal eligible in-custody persons and associated reimbursement, it is unknown at this time a percentage or dollar amount to be expected from billing services and the state claims processing time requirements for issuing payment.
Requested Action:
1. Approve Amendment No. 5 to Agreement 190201B with Wellpath LLC to extend the term an additional nine (9) months through June 30, 2027, and continue on a month-to-month basis for three (3) additional months.
2. Approval of a Budget Amendment increasing appropriations for Correction’s Medical/Laboratory Services (Fund 1000, Sub-Division 1400004 (Detention/Medical Services), Account 52220) by $985,600 with the use of General Fund available fund balance.
FISCAL IMPACT
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Is there a Fiscal Impact? |
Yes |
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Is it currently budgeted? |
No |
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Is it Mandatory or Discretionary? |
Mandatory |
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Is the general fund affected? |
Yes |
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Future fiscal impact: |
There is potential State revenue offset for some of the Correction’s and Probation’s Juvenile Hall medical services, but the General Fund will absorb the remainder of these costs. Allowable services will be billed to Medi-Cal. |
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Consequences if not approved: |
Providing medical services within the county jail and Juvenile Hall is a state mandate |
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Additional Information: |
Strategic Initiative: Build Healthy, Connected Communities |
ENVIRONMENTAL IMPACT
ENVIRONMENTAL DETERMINATION: The proposed action is not a project as defined by 14 California Code of Regulations 15378 (State CEQA Guidelines) and therefore CEQA is not applicable