Title
Health and Human Services Agency (HHSA) recommending the Board:
1) Designate HHSA to serve as the Administrative Entity (AE) for the El Dorado Opportunity Knocks (EDOK) Continuum of Care (CoC) for the Housing and Homelessness Incentive Program (HHIP), administered by the California Department of Health Care Services (DHCS), which provides incentive funding to Medi-Cal managed care health plans (MCPs) to support delivery and coordination of health and housing services for Medi-Cal members experiencing homelessness;
2) Delegate authority to the HHSA Director, or HHSA Deputy Director of Community Services, acting on behalf of HHSA as the AE for awarded EDOK CoC HHIP funds, to execute the HHIP grant agreement (Funding In Agreement 7698) awarded by Health Net, LLC and California Health & Wellness Plan (“the Health Plan”) as an MCP HHIP grantee, for the term effective upon execution through December 31, 2023, in the amount of $220,397; and
3) Authorize the HHSA Director, or HHSA Deputy Director of Community Services, to execute further documents related to the agreement, including amendments, that do not increase the maximum dollar amount, contingent upon County Counsel and Risk Management approval.
FUNDING: State funding matched by federal funds authorized pursuant to the American Rescue Plan Act of 2021, which are allocated by DHCS to managed care plans for collaboration with local continuums of care and to coordinate with the Homeless Housing Assistance and Prevention (HHAP) grant program.
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DISCUSSION / BACKGROUND:
In accordance with guidance from the Centers for Medicare and Medicaid Services related to Section 9817 of the American Rescue Plan Act of 2021, DHCS implemented the Medi-Cal Home and Community-Based Services (HCBS) Spending Plan, detailing a series of initiatives that will enhance, expand, and strengthen HCBS in California. Effective January 1, 2022, HHIP was implemented by DHCS as one of the initiatives of the HCBS, which aims to expand and enhance programs that facilitate individuals transitioning to community-based independent living arrangements.
On September 19, 2022, via All Plan Letter 22-007, DHCS notified Medi-Cal MCPs in California of the opportunity to participate in the voluntary HHIP funding program. Under the HHIP guidance, MCPs can earn incentive funds by making investments that improve health outcomes and expand access to whole person care services, by addressing homelessness and housing instabilities among Medi-Cal members who are at risk of, have recently experienced, or are experiencing homelessness. As designed, HHIP is intended to support delivery and coordination of health and housing services for Medi-Cal members, during the incentive program period of January 1, 2022, to December 31, 2023, by:
• Rewarding MCPs for developing the necessary capacity and partnerships to connect their Medi-Cal members to needed housing services; and
• Incentivizing MCPs to take an active role in reducing and preventing homelessness in their communities.
The application process for HHIP funds required participating MCPs to partner with the local homeless CoC, local public health, behavioral health, social services, housing and homelessness jurisdictions and Public Hospitals, to create a local Investment Plan (IP) describing how HHIP funds would be integrated into the homeless system of care in the participating jurisdiction. Plans had to be built off of existing homelessness reduction plans and be designed to address unmet needs. MCPs had to submit their finalized IPs to DHCS to be eligible for HHIP funding.
Within the County of El Dorado (County), three local MCPs: Anthem Blue Cross, Kaiser Permanente, and the Health Plan opted to participate in the HHIP funding opportunity. The MCP’s requested the local CoC, EDOK, partner with them in support of the HHIP application requirements. Thereafter, the EDOK CoC partnered with the MCPs, along with multiple County and community partners, to develop the homeless IP, with the investments planned to benefit Medi-Cal eligible members residing in the County. EDOK engaged and collaborated with these MCPs and other community partners/stakeholders, to provide input on each IP and reviewed the IPs prior to the MCP’s submission to DHCS. The IPs provided DHCS with general direction on the investments that each MCP planned to make to meet the HHIP program metrics in their jurisdiction.
As outlined in their IP submitted to DHCS, the Health Plan expressed their intent to award a portion of HHIP funds to the EDOK CoC, with the following housing and homelessness investments planned, which upon implementation in the County, will enable the MCP to meet HHIP metrics in the County as follows:
1. Enhance the EDOK CoC homeless Point-in-Time (PIT) Count processes, as mandated by the Department of Housing and Urban Development to be conducted bi-annually by local CoCs. Funds are to be used on behalf of the EDOK CoC as partial funding of an agreement with a PIT count provider for a Full-Service PIT Count, including volunteer recruitment, route planning, data management, analytics, and reporting; and
2. Improve Homeless Management Information System (HMIS) capacity, to include funding the transition to a new, more robust HMIS software solution including the first year and data transition costs and improve HMIS infrastructure in the County. Funds are to be directed to the County on behalf of the CoC as for long-term contracts and as the designated HMIS Lead for EDOK CoC. HHSA will work with the Information Technologies Department on the new HMIS software solution and request approval of the project with the Information Technologies Steering Committee once the HMIS system improvements project has been developed further.
Within the County, the EDOK CoC is a regional planning body of representatives that coordinates policies, strategies, and activities toward preventing and ending homelessness. In order for the EDOK CoC to receive or expend awarded HHIP funding, the EDOK CoC is required to designate an AE, which is defined as a unit of general-purpose local government (City or County), a Joint Powers Authority, or a nonprofit organization that has previously administered federal United States Department of Housing and Urban Development (HUD) CoC funds as the Collaborative Applicant, pursuant to Section 578.3 of Title 24 of the Code of Federal Regulations, and designated by the CoC to administer program funds. The El Dorado County Board of Supervisors (Board) has previously designated HHSA to act as the AE on behalf of the EDOK CoC for grant programs funding housing and homeless services within the County of El Dorado. Subsequently, the Board is being asked to designate HHSA to also serve as the AE for the EDOK CoC for funds awarded through the HHIP funding program.
HHIP investments are contingent on the MCPs meeting HHIP metrics over the two-year HHIP program period. To this end, the EDOK CoC and HHSA Housing and Homelessness Services is committed to collaborating with the MCPs as they engage locally to meet HHIP program metrics. The Health Plan granted HHSA, as the AE for the EDOK CoC HHIP funds, a total grant in the amount of $220,397 to support future PIT Counts and to implement HMIS software solutions in the County, in accordance with the IP metrics the Health Plan committed to the DHCS.
ALTERNATIVES:
Should the Board decline to approve these recommendations, the Health Plan may fail to complete all requirements necessary for the HHIP funding incentive metrics, and the EDOK CoC would not receive $220,397 in funding to expend on mandated PIT Count activities and planned HMIS system improvements.
PRIOR BOARD ACTION:
1) 01/03/23, File ID 22-2221, HHSA Housing and Homelessness Incentive Program (Anthem Blue Cross HHIP Grant Agreement)
2) 05/09/23, File ID 23-0620, HHSA Permanente Medical Group, HHIP 7580
OTHER DEPARTMENT / AGENCY INVOLVEMENT:
Risk Management and County Counsel.
CAO RECOMMENDATION:
Approve as recommended.
FINANCIAL IMPACT:
There is no General Fund Cost associated with this Agenda item. Sufficient revenue and appropriations were included in the current fiscal year budget and will be included in future budgets for the term of the funding agreement.
CLERK OF THE BOARD FOLLOW UP ACTIONS
N/A
STRATEGIC PLAN COMPONENT:
Healthy Communities
CONTACT
Olivia Byron-Cooper, MPH, Interim Director, Health and Human Services Agency