Title
Health and Human Services Agency (HHSA) recommending the Board:
1) Receive and file a fee study report dated June 2024, performed by MGT Consulting (MGT) for HHSA Senior Day Care and Public Guardian fee-related services;
2) Provide direction to staff on the fees recommended by MGT and how to proceed with the fee updates for both Senior Day Care and Public Guardian, with the options and fee changes/increase recommendations:
a) Direct staff to return with a resolution to increase Senior Day Care Program fees by:
i. Distributing the recommended increases evenly across a three-year implementation period, to ease the financial impact to families served, as recommended by staff to achieve a 97% recovery level after three years; or
ii. Increase fees in the first year for 80% recovery level;
b) Direct staff to return with a resolution to increase Public Guardian Program fees as recommended by staff; which equates to a 37% recovery of County costs; and
c) Provide alternative direction for next steps staff should take on Senior Day Care and Public Guardian fees.
FUNDING: Fees for Service and County General Fund.
Body
DISCUSSION / BACKGROUND:
HHSA Community Services and Behavioral Health commissioned a fee study conducted by MGT for Public Guardian and Senior Day Care sites. The primary goals of the study were to determine what it costs the County to provide the various fee-related services, determine whether there are any services where a fee should be collected, identify service areas where the County might adjust fees based on the full cost of services and other economic or policy considerations, and develop revenue projections based on recommended increases or decreases to fees.
On September 13, 2016, the Board adopted Resolution 148-2016 establishing the Fee Schedule for Senior Day Care (Legistar file 16-0805, V. 2). On September 12, 2017, the Board adopted Resolution 142-2017 revising the Fee Schedule for the Public Guardian (Legistar file 16-0805, V. 3). The fees for both programs were developed pursuant to a cost analysis provided by MGT and are still in use by the programs.
HHSA provides numerous services to individuals which are paid for on a fee basis, including some provided by Senior Day Care and Public Guardian. Most are paid for by program funding and grants; however, some services are paid for in whole or in part by fees charged to the client.
The County Older Adult Services programs operates two Adult Day Service Program facilities which help adults remain active and involved in their community - one in Placerville and one in El Dorado Hills. The Senior Day Care program serves adults who need care and supervision during the day. This service provides families with peace of mind and the opportunity to take a break from their caregiving responsibilities or continue their employment. The services result in improved living conditions for disabled or elderly adults who are not able to care for themselves, and their caregivers. For Fiscal Year (FY) 2024-25, the program has an estimated General Fund cost of $666,000 with an average of 7.5 participants per site with 261 workdays in FY 2024-25 which equates to an estimated General Fund subsidy of $170 per participant per day.
The Office of the Public Guardian (Public Guardian) serves as conservator of a person and/or estate of individuals needing protective intervention, to ensure the physical and financial safety of persons unable to do so on their own, when there are no viable alternatives to a public conservatorship. The two types of conservatorships, Lanterman-Petris-Short (LPS) and probate, can only be established by order of the Superior Court and may be for person only, estate only, or for both person and estate. As probate conservator, the Public Guardian is involved in all aspects of their clients’ lives, including financial management, housing, medical care, placement, and advocacy. As LPS conservator, the Public Guardian is responsible for directing the mental health treatment and placement of clients who are gravely disabled and unable to provide for their food, clothing, shelter, and treatment needs. Public Guardian also provides voluntary Representative Payee Program services to assist individuals with financial management and case management. For FY 2024-25, the program has an estimated General Fund cost of $2,087,016.
The MGT fee study report details the full cost of services for both Senior Day Care and Public Guardian and presents recommended fee adjustments and their fiscal impact on County’s revenues. The key summary of recommendations included in the report are highlighted below.
Senior Day Care Fee Changes
No new fees were recommended for Senior Day Care, however MGT recommended increasing service-related fees. The analysis performed by MGT along with the Senior Day Care program result in the following changes/increases to current fees:
a) Recommend increasing the one-time Enrollment Fee from $50 to $333, resulting in a 50% recovery of County costs;
b) Recommend increasing the Extended Hourly Fees from $10 to $91 per 30 minutes, resulting in 100% recovery of County costs;
c) Recommend increasing the Late Fees from $2 to $4.45 per minute, resulting in 100% recovery of the County costs; and
d) Recommend the removal of the Client Shower Assistance Fee ($25 per event).
MGT provided two Senior Day Care fee increase options, both of which result in the recovery of the County costs associated with the impacted fees. The options for implementing the increases are presented to the Board below:
a) The first option increases service-related fees in the first year period, all at once. This option proposes an 80% recovery level of the County annual costs associated with the Senior Day Care Fee category, through an increase in the daily rate from $58 to $100 per day. The total fiscal impact of this option is projected to increase Fees for Service revenue by $203,159 at the end of year one.
b) The second option distributes the recommended increases to all service-related fees evenly across a three-year implementation period, to ease the financial impact to families served. This option proposes a 97% recovery level of the annual County costs associated with the Senior Day Care Fee category, through an increase in the daily rate from $58 to $122.67 per day. The total fiscal impact of this option is projected to increase County Fees for Service revenue by $303,884 at the end of year three.
HHSA recommends option b above as this option proposes a 97% recovery level over a 3-year implementation period with an annual Net Budget General Fund Savings of $355,162.
Public Guardian Fee Changes
The following increased or new Public Guardian fee additions are recommended by MGT and Public Guardian staff:
a) A new fee of $648 per year for Estate/Trust Management, which equates to a 37% recovery of County costs. There is currently no fee for this service.
b) A revision in the extended hour fees pursuant to Extraordinary Compensation as defined by 2016 California Code, Rule 7.703, which increases this fee from $110 per hour to $149 per hour fee, which is a 95% recovery of County costs.
c) A new one-time application fee of $807 for New Case Enrollments, which equates to a 37% recovery of County costs. There is currently no fee for this service.
d) A revision in the Annual Fee to change the fee from its current $110 per hour to a $1,500 per year flat fee, which equates to a 37% recovery of County costs.
The total fiscal impact of implementing these fee changes in Public Guardian is projected to increase County revenue in total by $587,512 annually.
ALTERNATIVES:
Should the Board decline to approve the recommendations put forth in the fee schedule, the current fees would remain the same for HHSA Senior Day Program and Office of Public Guardian, resulting in continued increase in General Fund expenditures.
PRIOR BOARD ACTION:
08/30/16, 16-0805 V.1, HHSA, Resolution Establishing Fees for Fiscal Year 2016-2017
09/13/16, 16-0805 V. 2, HHSA, Resolution Establishing Fees for Fiscal Year 2016-2017
09/12/17, 16-0805 V. 3, HHSA, Resolution Revising Public Guardian Fees for Fiscal Year 2017-2018
OTHER DEPARTMENT / AGENCY INVOLVEMENT:
N/A
CAO RECOMMENDATION:
Approve as recommended.
FINANCIAL IMPACT:
There is no Net County Cost associated with this agenda item, as staff will return to the Board with the fee changes after direction is provided with this item. The Senior Day Care and Public Guardian programs are funded primarily with General Fund dollars, offset by any fee revenue that is received. Therefore, changes to the fee structure have the potential to increase or decrease the General Fund cost of the programs.
CLERK OF THE BOARD FOLLOW UP ACTIONS:
N/A
STRATEGIC PLAN COMPONENT:
N/A
CONTACT:
Olivia Byron-Cooper, MPH, Director, Health and Human Services Agency