TO: Board of Supervisors
FROM: Ryan J Alsop, County Executive Officer
REPORT BY: Daniel Sanchez, Senior Management Analyst
SUBJECT: Amendment No. 3 to Agreement 190201B with Wellpath Management, Inc.
RECOMMENDATION
title
Approve Amendment No. 3 to Agreement 190201B with California Forensic Medical Group, Inc., dba Wellpath Management, Inc to provide health care services to incarcerated persons in custody to the Napa County Department of Corrections and wards housed at the Juvenile Justice Facility through June 30, 2026. (Fiscal Impact: $6,371,524 Expense; General Fund; Budgeted; Mandatory)
body
BACKGROUND
Napa County entered into Agreement No. 190201B to provide specialized medical services on December 18, 2018. Staff is requesting a contract amendment before Requests for Proposals (RFP) are issued in the fall of 2025 for medical services in the jail and juvenile justice facility.
Due to the replacement jail opening, and significant changes to laws governing medical services in correctional facilities, staff is asking for an amendment for an additional year before the existing contract expires at the end of this fiscal year.
The revised agreement increases the expenses for the Department of Corrections and the Probation Department for the remainder of this current fiscal year. The added expenses will only apply to the final two months of Fiscal Year 2024-25 and will be absorbed by the departments in their existing budget. The Amendment increases Wellpath staffing an additional 5.925 Full Time Equivalent (FTE) contract positions.
The Department of Corrections is requesting an increase in healthcare staffing of 4.20 FTE positions. From this increase, 2.80 FTE nurses are needed to comply with AB268. This legislation requires new standards of care for incarcerated people with mental health issues. This includes mental health screenings upon booking or intake. The screening must be conducted by a qualified mental health care professional. A qualified mental health care professional can include a physician, physician assistant, nurse, nurse practitioner, or psychologist, among other professionals. Because the jail operates continuously, 2.10 FTE positions are needed to cover night shifts and .70 FTE to provide enhanced coverage during day shifts.
Discharge planning is required by Title 15 Minimum Standards for Local Detention Facilities. A 1.0 FTE Charge Nurse/Discharge Planner is requested to coordinate medical appointments, durable medical equipment, and medications that IPs will need when released into the community. This position will also orient and train staff, direct daily activities, organize Provider and Specialty clinics, and lead Medication-Assisted Treatment (MAT) programming. Also requested is a .40 FTE Physician’s Assistant (PA). The PA can prescribe medication and treat IPs with less serious medical conditions that do not require the services of a physician and can assist the physician as needed. The PA will conduct initial physical examinations within fourteen days of incarceration and semi-annually thereafter, as required by Title 15. Currently there is a backlog of health assessments that the PA will help address.
The Juvenile Hall is also required to comply with AB 268 and therefore will add a 1.10 FTE Registered Nurse. This position covers required hours of intake to comply with Title 15 regulations and AB 268 as well as additional night hours for nighttime medication distribution to ensure youth receive medication at the appropriate times. Additionally, due to increased mental health needs of youth, an additional 0.125 FTE Psychiatrist is requested to meet the needs of youth psychiatric medication requirements on an as needed basis as well as hire a 0.50 FTE Administrative Assistant closer to the end of the Fiscal Year 2025-26 and the start date of the CalAim initiative. This contract will help to comply with State initiatives to advance and create a more coordinated, person-centered, equitable health system and accessible Medi-Cal program for youth housed in the Juvenile Hall upon their return to the community.
Wellpath Management Inc. is currently going through Chapter 11 Bankruptcy proceedings in the Southern District of Texas. Napa County is not a Wellpath vendor and is not currently affected by these proceedings. Wellpath’s Disclosure Statement was accepted by the Bankruptcy Court on March 14, 2025, and a global settlement between the debtors, committee, lenders, and HIG Capital was announced at an emergency hearing on April 16, 2025. Wellpath has proposed a Chapter 11 reorganization plan that is scheduled for a confirmation hearing on April 30th, 2025.
Requested Action:
Approve Amendment No. 3 to Agreement 190201B with California Forensic Medical Group, Inc., dba Wellpath Management, Inc., from May 1, 2025, through June 30, 2026 for a contract maximum of $6,371,524 for health care services to incarcerated persons in custody to the Napa County Department of Corrections and wards housed at the Juvenile Justice Facility.
FISCAL & STRATEGIC PLAN IMPACT
|
Is there a Fiscal Impact? |
Yes |
|
Is it currently budgeted? |
Yes |
|
Where is it budgeted? |
The contract amendment will be absorbed within the current department budgets. The Fiscal Year 2025-26 Recommended Budget includes the costs of this agreement within the department budgets. |
|
Is it Mandatory or Discretionary? |
Mandatory |
|
Is the general fund affected? |
Yes |
|
Future fiscal impact: |
There is potential State revenue offset for some of the Probation’s Juvenile Hall medical services, but the General Fund will absorb the remainder of these costs. |
|
Consequences if not approved: |
Providing medical services within the county jail and Juvenile Hall is a state mandate. |
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.