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Health and Human Services Agency recommending the Board:
1) Approve the Children’s Medical Services Program Budgets and Work Plans for the County of El Dorado for Fiscal Year 2018-2019 for the provision of required preventive and specialized health care services to children from birth to 21 years of age who are afflicted with life-threatening and/or severe life-altering chronic medical conditions, with an estimated maximum reimbursement amount of $1,076,198;
2) Delegate authority to the HHSA Director to execute the Certification Statements and any additional documents related to this funding, if any; and
3) Authorize the HHSA Director, Assistant Director of Administration and Finance, or the Chief Fiscal Officer to execute any required fiscal and programmatic reports.
FUNDING: 59% Federal Children’s Medical Services Allocation, 32% State Children’s Medical Services Allocations, 6% Public Health Realignment Fund Match, 1% Social Services Realignment Fund Match, and 1% County General Fund Match.
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DISCUSSION / BACKGROUND:
The Children’s Medical Services Program consists of the Child Health and Disability Prevention (CHDP) Program and the California Children’s Services (CCS) Program. These are mandated safety net programs that target high risk and medically fragile children to ensure access to preventative and specialty medical care. These mandated programs are essential for preserving optimal health and wellness while minimizing morbidity and mortality in the County's pediatric population.
Funding for local CCS services is administered as a partnership between the County, California State Department of Health Care Services (DHCS) and the Federal Government. In accordance with Health and Safety Code Section 123940, the Board must annually allocate twenty-five percent (25%) of the annual program expenditure to a level at least equivalent to the actual FY 1990-91 contribution, and an additional 25% from the County Social Services Trust Account. The annual funding allocation for CHDP and CCS programs each fiscal year has an effective date of July 1 through June 30. Historically, the allocation is finalized by the State after the Governor signs the State’s budget.
On September 27, 2018, the DHCS notified Health and Human Services Agency (HHSA) of the final CHDP Program allocation for FY 2018- 2019. The Budgets and Work Plans were developed and submitted by the deadline established by DHCS. In order for HHSA to claim expenditures against this funding allocation, Board approval of the attached Budgets and Work Plans is required and then the submission of the certifications to DHCS.
ALTERNATIVES:
The services outlined in the CMS workplans are mandated at the local level through a variety of statutes including, but not limited to California Health and Safety Code, Welfare and Institution Code, Government Code, Code of California Regulations Title 17, Code of California Regulations Title 22, Code of Federal Regulations Title 42, and the Social Security Act (42 USC).
Failure to endorse and submit the workplans to the State would discontinue services to approximately 700 children, countywide. In addition, it would mean the disruption to general health care oversight and care coordination to all children currently placed in Foster Care and who could be placed in Foster Care.
Lastly, noncompliance with the mandated services could result in the State placing sanctions on the County.
PRIOR BOARD ACTION:
12-05-2017 File ID 12-1479, Version 6 Approved
12-06-2016 File ID 12-1479, Version 5 Approved
01-26-2016 File ID 12-1479, Version 4 Approved
OTHER DEPARTMENT / AGENCY INVOLVEMENT:
N/A
CAO RECOMMENDATION:
It is recommended that the Board approve this item.
FINANCIAL IMPACT:
The majority of the revenue that pays for costs of the CHDP and CCS programs is from Federal Children’s Medical Services allocations (approximately 59%). The next largest portion of revenue is from the State Children’s Medical Services allocations (approximately 32%). Actual staff time spent in these programs are billed to the State. A complicated worksheet is used to bill the State who reimburses HHSA with the appropriate mix of federal and state monies. Matching amounts are comprised of a mixture of Social Services Realignment, Public Health Realignment, and County General Fund.
The estimated County General Fund match in Fiscal Year (FY) 2018-2019 is $15,961 and is included in the HHSA FY 2018-2019 Budget.
Sufficient revenue appropriations were included in HHSA’s FY 2018-2019 Budget.
Starting in FY 2018-2019 there is a new requirement from DHCS that Public Health Nursing (PHN) staff are to provide Caseload Relief services within the Health Care Program for Children in Foster Care. DHCS will reimburse HHSA for providing the services.
Additionally, the revenue provided by this agreement and the County match provide the means for PHN staff to provide general health care oversight and care coordination for all children currently placed in Foster Care (currently 357 children). The PH nurses are responsible for the highly specialized monitoring of those children in placement receiving psychotropic pharmacotherapy.
This Agenda Item is a renewal of annual funding to various Public Health Nursing programs. Estimated revenue rates of the Programs for this year and the last two years are as follows:
FY 2018-2019: Total estimated revenue is $1,076,198, which is a 13% increase over FY 2017-2018. This includes the first year that Caseload Relief services were included within the Health Care Program for Children in Foster Care.
FY 2017-2018: Total estimated revenue was $956,587, which was a 1% increase over FY 2016-2017. This was the first year that Psychotropic Medication Monitoring and Oversight services were included within the Health Care Program for Children in Foster Care.
FY 2016-2017: Total estimated revenue was $944,763, which was a 1% increase over FY 2015-2016.
CLERK OF THE BOARD FOLLOW UP ACTIONS
Clerk of the Board to provide a Certified Minute Order to HHSA Contracts Unit at 3057 Briw Road.
STRATEGIC PLAN COMPONENT:
HHSA Strategic Plan. Goal 2 - Fiscal Responsibility: To develop and sustain Agency resources through thoughtful planning and efficient practices, and foster accountability and ownership at all levels of the Agency.
CONTACT
Patricia Charles-Heathers, Ph.D., M.P.A., Director