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Health and Human Services Agency (HHSA) recommending the Board:
1) Approve and authorize the Chair to sign Funding Out Agreement 9084 with El Dorado County Community Health Center (EDCHC) for the purchase of dental equipment for installment at a new EDCHC dental location in South Lake Tahoe, in the amount of $400,000 and for the term upon execution through December 31, 2025;
2) Authorize the Purchasing Agent to execute amendments relating to Agreement 9084 which do not increase the maximum dollar amount or extend the term of the agreement beyond December 31, 2026, contingent upon approval by County Counsel and Risk Management; and
3) Authorize the HHSA Director, or the Chief Assistant Director, to execute programmatic, administrative, and fiscal documents relating to Agreement 9084.
FUNDING: 100% Coronavirus State and Local Fiscal Recovery Funds program authorized under the American Rescue Plan Act of 2021.
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DISCUSSION / BACKGROUND:
The COVID-19 pandemic significantly disrupted access to oral health care services in El Dorado County (EDC), particularly in South Lake Tahoe (SLT). Dental services in SLT are critical for improving the health and quality of life for children and the broader community. Between 2021-2023, the number of dental providers accepting Medi-Cal was drastically reduced due to the pandemic. As of April 2024, no Medi-Cal-accepting dental provider remained in the SLT basin.
The pandemic forced many dental practices to close temporarily or reduce services, impacting providers serving vulnerable populations, including Medi-Cal recipients. The SLT community, already underserved in dental care before the pandemic, has seen further decline in access with the nearest Medi-Cal dentist now located in Placerville creating significant barriers to care. HHSA's Public Health Division (PHD) realized that every day that passed without a stable dental provider in SLT was a day of decline, impact, and potential illness that was going unchecked. In the 2023-2024 Kindergarten Oral Health Assessment, nearly 20% of SLT students assessed had untreated dental cavities where dental treatment was recommended and nearly 10% had urgent dental needs requiring immediate dental care. Ensuring adequate dental services for all EDC residents is a priority of the HHSA. Although HHSA doesn’t provide direct dental services, it works to partner with service providers who do provide dental services whenever possible. It became apparent that what prohibited dental care operations was both financial, operational, and logistical. Someone would have to provide the fiscal support necessary for equipment, facility, medical/dental providers, and medications. Currently, the EDCHC is the only dental provider willing to accept Medi-Cal insurance for dental services in SLT.
On July 15, 2024, the EDCHC submitted a Dental Services Proposal to HHSA PHD to open a new dental clinic in SLT which will service Medi-Cal patients. The proposal outlined the site location and construction requirements for the clinic, necessary equipment and supplies, staffing plans, and a phased timeline for opening and operationalizing the facility.
To support this effort, HHSA PHD identified cost savings within the Board’s allocation of ARPA SLFRF to the PHD of HHSA to fund the purchase of dental equipment for the new clinic. This funding will come from the U.S. Treasury's SLFRF program, authorized under ARPA. The SLFRF program requires funding recipients to comply with federal procurement requirements as set forth in 2 Code of Federal Regulations (CFR) 200.318 through 2 CFR 200.327. HHSA PHD proceeded with the noncompetitive procurement exemption for sole sourcing as outlined in 2 CFR 200.320(c)(2) to meet the federal procurement requirements, as EDCHC is the only provider in SLT that will provide the critical dental services.
A total of $400,000 has been allocated for this purpose, with a contract term beginning upon execution through December 31, 2025. These funds will be specifically restricted to the purchase of dental equipment necessary to operationalize the SLT site. Before any funds are disbursed, EDCHC is required to have a contract in place for the lease of the new dental site in SLT, with a minimum lease term of five years. This requirement ensures that the investment in dental equipment will be used for a sustained period, helping to secure long-term access to dental care for the community.
HHSA PHD recommends the Board approve Funding Out Agreement 9084 to address the critical gap in oral health services for vulnerable populations in SLT.
ALTERNATIVES:
Should the Board decline to approve this recommendation, HHSA PHD would need to identify an alternate plan to address the limited Medi-Cal oral health care providers in SLT.
PRIOR BOARD ACTION:
N/A
OTHER DEPARTMENT / AGENCY INVOLVEMENT:
Approved by County Counsel and Risk Management. The Auditor-Controller has been notified per Policy B-12.
CAO RECOMMENDATION:
Approve as recommended.
FINANCIAL IMPACT:
There is no General Fund Cost associated with this agenda item. Sufficient appropriations were included in the Fiscal Year 2024-25 Budget and will be included in future budgets for the term of the Agreement. The agreement is being funding with 100% ARPA SLFRF allocated to HHSA.
CLERK OF THE BOARD FOLLOW UP ACTIONS:
Clerk of the Board to obtain signature of Chair on one original Funding Out Agreement 9084.
STRATEGIC PLAN COMPONENT:
N/A
CONTACT
Olivia Byron-Cooper, MPH, Director, Health and Human Services Agency