REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
March 14, 2023
FROM
JOSHUA DUGAS, Director, Department of Public Health
SUBJECT
Title
Integrated Systems of Care Division for California Children’s Services Plan and Allocations
End
RECOMMENDATION(S)
Recommendation
1. Approve submission of the Department of Public Health’s 2022-23 Integrated Systems of Care Division Plan for California Children’s Services, to the California Department of Health Care Services, in the amount of $12,544,344, for the period of July 1, 2022, through June 30, 2023.
2. Accept allocations from the California Department of Health Care Services for the Department of Public Health’s Integrated Systems of Care Division Plan, in the amount of $11,509,368, for the period of July 1, 2022, through June 30, 2023.
(Presenter: Joshua Dugas, Director, 387-9146)
Body
COUNTY AND CHIEF EXECUTIVE OFFICER GOALS & OBJECTIVES
Provide for the Safety, Health and Social Service Needs of County Residents.
Pursue County Goals and Objectives by Working with Other Agencies and Stakeholders.
FINANCIAL IMPACT
This item does not require additional Discretionary General Funding (Net County Cost). The Department of Public Health (DPH) Integrated Systems of Care Division (ISCD) Plan and allocation of $12,544,344 includes the required California Children’s Services (CCS) match of $422,252, comprised of $211,126 each of 1991 Realignment and Discretionary General Funding. Funds will be used to reimburse costs incurred from July 1, 2022, and are anticipated to be fully expended by June 30, 2023. The ISCD CCS Plan referenced in the above Recommendation No. 1 exceeds the allocation received from the California Department of Health Care Services (DHCS) as it includes match dollars and estimated additional budgeted costs of $612,724. Adequate appropriation, revenue, and the Discretionary General Funding match have been included in DPH’s 2022-23 budget.
BACKGROUND INFORMATION
The DHCS funds are issued to local health jurisdictions to serve high-risk families, infants, children, and youth with numerous health conditions through the CCS and CHDP programs. These programs are administered through a partnership between county health departments and DHCS, via its ISCD. The collective goal of the programs is to ensure these populations have and maintain access to needed medical, dental, and specialty health services through case management, professional consultation, and linkage to appropriate levels of care. DPH has received funding for these programs since 1974.
Annually, DHCS issues local county health department allocation notices for the CCS program identifying annual funding and, in return, the local county health department must submit an ISCD Plan to DHCS identifying how the program’s funds will be used.
On January 24, 2023, DPH received Information Notice 23-01 providing the 2022-23 CCS Program Allocation in the amount of $11,509,368. DHCS requires the submitted ISCD Plan to be developed based on the caseload percentages [Medi-Cal, Straight CCS, and Optional Targeted Low Income Children’s Program (OTLICP) caseloads], but the actual allocations are developed based on the total amount of funding available for the State and the percentage requested in each caseload category by each county in the State with verification that DPH will meet the required match. Additionally, the CCS County budget and the ISCD Plan are developed for July 1, 2022, through June 30, 2023, while the State allocations cover the period of April 1, 2022, through March 31, 2023, due to the county working under an accrual basis and the State working under a cash basis. Due to these accounting periods being concurrent for only nine of 12 months, there are variances between the allocated amount on the Information Notice 23-01 and the amount budgeted on the ISCD Plan. The County’s required local match of $422,252 will allow drawdown of the full allocation amount.
The CCS Program allocation and local match total $11,931,620. The total is less than the $12,544,344 CCS Administrative Baseline Budget within the ISCD Plan, prepared in August 2022, due to DHCS by March 30, 2023. The ISCD Plan is developed using State caseload standards for staffing. The program monitors caseloads and expenditures on an on-going basis to optimize resource utilization. Historically, actual administrative costs have been below budget as a result. The 2022-23 ISCD Plan totaling $12,544,344 is the best estimate of the cost to provide these services. The difference between the funding allocation and actual cost will be met by local match unless supplementary State funds become available, if needed.
CCS provides mandated services that are required to meet the needs of its client base. Historically, the State would make supplemental allocations if the original allocation and local match did not meet actual expenses incurred. The use of additional 1991 Realignment would be necessary if supplemental funding is needed but not provided by the State in the future.
The CCS program provides diagnostic and treatment services, medical case management, and physical and occupational therapy services for children under the age of 21 with medically eligible conditions such as cystic fibrosis, hemophilia, cerebral palsy, heart disease, cancer, and traumatic injuries. DPH estimates this funding will provide 14,412 children with CCS program services at an average cost of $870 per child.
The Board of Supervisors’ approval of the DPH 2022-23 ISCD Plan represents DPH’s agreement to comply with all Federal and State requirements pertaining to the CCS program and adherence to all applicable policies and procedures set forth by DHCS. In addition, approval of DPH’s 2022-23 ISCD Plan constitutes acceptance of the CCS program allocations.
This item is being presented at this time, as this is the first date available for presentation following the required operational, fiscal, and legal reviews. Approval at this time will have no impact on DPH’s CCS program services and activities.
PROCUREMENT
N/A
REVIEW BY OTHERS
This item has been reviewed by County Counsel (Adam Ebright, County Counsel, 387-5455) on March 1, 2023; Finance (Paul Garcia, Administrative Analyst, 386-8392) on March 1, 2023; and County Finance and Administration (Cheryl Adams, Deputy Executive Officer, 388-0238) on March 3, 2023.