TO: Board of Supervisors
FROM: AJ Alarcón, Interim Director of Corrections
REPORT BY: Daniel Sanchez, Staff Services Manager
SUBJECT: MOU with Golden State Finance Authority
RECOMMENDATION
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Adopt a Memorandum of Understanding with the Golden State Finance Authority to provide cost reimbursement for participation in a regional Jail Medical Care Feasibility Study to evaluate the long-term alternatives for jail medical service delivery. (Fiscal Impact: $42,500 Expense; General Fund; Budgeted; Discretionary)
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BACKGROUND
Counties throughout California are challenged by the rising cost and complexity of providing legally required medical care to individuals housed in county jails. Many counties face persistent staffing shortages, escalating contract costs and potential for litigation. These challenges are especially pronounced in rural and mid-sized counties.
The costs for jail medical services have increased alongside expanded regulatory requirements and higher expectations for specialized medical services and behavioral health. Counties across the state have experienced the potential for litigation and liability exposure related to jail medical care. Public Risk Innovation, Solutions and Management (PRISM) is a joint powers authority. Each member-county appoints a board member and one alternative board member to serve on the PRISM Board of Directors.
PRISM noted recent cases involving in-custody deaths and medical care claims that resulted in multimillion-dollar settlement demands and increased county costs. To respond to these challenges, the Rural County Representatives of California (RCRC), in partnership with PRISM, convened a five regional task force in 2025. The task force explored long-term strategies for improving the delivery, quality, cost-effectiveness and risk management of jail medical care, including the potential for regional collaboration. The Golden State Finance Authority (GSFA), RCRC’s affiliated public agency, issues Request for Proposals to procure a qualified consultant to conduct a feasibility study evaluating alternative models for jail medical care. The feasibility study is intended to support counties in assessing regional collaboration opportunities, cost-effective service delivery approaches, quality-of-care considerations and compliance with applicable state and national standards.
Today’s action will approve the MOU to participate in the Jail Medical Care Feasibility Study. Napa County will partner with GSFA to fund and participate in a coordinated evaluation of long-term jail medical care alternatives along other rural California counties.
FISCAL IMPACT
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Is there a Fiscal Impact? |
Yes |
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Is it currently budgeted? |
Yes |
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Where is it budgeted? |
General Fund |
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Is it Mandatory or Discretionary? |
Discretionary |
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Discretionary Justification: |
This MOU will allow the Bay Area Region composed of Sonoma, Solano and Napa Counties to evaluate the most sustainable, long-term solutions to jail medical service delivery. |
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Is the general fund affected? |
Yes |
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Future fiscal impact: |
This is a one-time cost with no future fiscal impact. |
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Consequences if not approved: |
If this MOU is not approved Napa County will not have the opportunity to participate in regional solutions for jail medical service delivery. |
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Strategic Initiative |
Elevate County Service and Workforce Excellence |
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.