TO: Board of Supervisors
FROM: Dina Jose, Director of Corrections
REPORT BY: Sue Kuss, Staff Services Manager
SUBJECT: Accept CalAIM Path Justice-Involved Grant from Department of Health Care Services (DHCS)
RECOMMENDATION
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Accept grant funding from the California Department of Health Care Services (DHCS) and approve a Budget Amendment, for the term April 1, 2024, through submission of the final progress report to implement targeted pre-release Medi-Cal services to incarcerate persons. (Fiscal Impact $3,500,000 revenue, General Fund, Not budgeted; Discretionary)
[4/5 vote required]
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BACKGROUND
According to DHCS, approximately 400,000 individuals are released from correctional facilities each year. Of these individuals, 80-90% are eligible for Medi-Cal. Formerly incarcerated persons (IP) are more likely to experience poor health outcomes and face disproportionately higher rates of physical and behavioral health diagnoses. They are also at higher risk for overdose and suicide.
DHCS received federal approval under its California Advancing and Innovating Medi-Cal (CalAIM) 1115 Demonstration for Providing Access and Transferring Health (PATH) capacity building funds to support this justice-involved re-entry initiative. The CalAIM initiative aims to improve health outcomes of this community by connecting incarcerated persons with medical, behavioral, and social services that begin 90 days before release and continue into the incarcerated person’s re-entry to the community. Correctional facilities must implement CalAIM no later than October 1, 2026.
As a first step of the CalAIM initiative, the Corrections Department and Health & Human Services Administration (HHSA) worked together to implement a pre-release Medi-Cal application process by January 1, 2023. Work now begins on the enhanced care management component required by CalAIM. It is the intention of the Corrections Department to contract with the County’s provider of inmate ward health care (currently Wellpath) to implement the activities under the Path 3 grant to create a re-entry care management plan to provide a warm handoff from medical and behavioral health care providers in the Jail to community partners.
Grant activities include coordinating medication and durable medical equipment needs of the incarcerated persons and coordinating medical appointments with medical/behavioral health partners in the community. The Wellpath employees will also execute a medication-assisted treatment (MAT). The MAT program will focus on opioid-dependent IPs, provide substance abuse counseling services, and eligible IPs will receive drug treatment. Wellpath will provide medications, laboratory tests, and drug screenings to support the MAT program. Wellpath will also provide consultation services to recruit, hire, and train the Cal-AIM staff and ensure compliance with grant requirements. The details of the contract are currently being negotiated.
The grant is intended to fund startup costs. Ongoing costs will be recovered by billing expenses to Medi-Cal.
No new County employees will be hired and paid by the grant.
Requested Actions:
1. Accept grant funds of $3,500,000 for pre-release Medi-Cal services; $2,450,000 of this amount will be received in Fiscal Year 2023-24. The remainder of the grant, $1,050,000 will be received in Fiscal Year 2024-25.
2. Approve a budget amendment increasing Fiscal Year 2023-24 budget appropriations for inmate health care services in the amount of $2,450,000 in Division 14000 offset by an increase in Federal Revenues. The balance of the grant is budgeted in Fiscal Year 2024-25.
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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Where is it budgeted? |
1400004 |
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Is it Mandatory or Discretionary? |
Discretionary |
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Discretionary Justification: |
Pre-release Medi-Cal services for incarcerated persons are mandated. Applying for and accepting a grant to support these services is discretionary. |
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Is the general fund affected? |
No |
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Future fiscal impact: |
Ongoing expenses beyond the term of the grant may be eligible for Medi-Cal reimbursement. |
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Consequences if not approved: |
If the grant is not accepted, the general fund will pay for 100% of the costs associated with implementing pre-release services although these costs will be partially offset by reimbursement from Medi-Cal. |
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Additional Information |
It is the intentional of NCDC to contract with Wellpath, the IP healthcare provider, to implement the Cal-AIM grant activities detailed in the Background section. The contract amendment with Wellpath is still being negotiated. |
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.