REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
September 1, 2026
FROM
ANDREW GOLDFRACH, ARMC Chief Executive Officer, Arrowhead Regional Medical Center
SUBJECT
Title
Grant Application to the California Department of Health Care Access and Information for the California Rural Healthcare Transformation Initiative 1: Transformative Care Model Expand and Support Rural Workforce Capacity Program
End
RECOMMENDATION(S)
Recommendation
1. Ratify the submission of the grant application by the ARMC Chief Executive Officer to the California Department of Health Care Access and Information, for the California Rural Healthcare Transformation Initiative 1 - Transformative Care Model Expand and Support Rural Workforce Capacity Program, in the amount of $500,000, for the grant performance period of October 1, 2026 through September 30, 2027.
2. Authorize the ARMC Chief Executive Officer to approve and execute the grant agreement with the California Department of Health Care Access or its administrator, if awarded, in the estimated amount of $500,000, for the period of October 1, 2026 through September 30, 2027, subject to review by County Counsel.
3. Direct the ARMC Chief Executive Officer to submit the executed grant award agreement, if awarded, to the Board of Supervisors for ratification.
(Presenter: Andrew Goldfrach, ARMC Chief Executive Officer, 580-6150)
Body
COUNTY AND CHIEF EXECUTIVE OFFICER GOALS & OBJECTIVES.
Foster Sustainable Development Through Strategic Partnerships.
Provide for the Safety, Health and Social Service Needs of County Residents.
FINANCIAL IMPACT
Approval of this item will not result in the use of Discretionary General Funding (Net County Cost). The California Department of Health Care Access and Information (HCAI) through the California Rural Healthcare Transformation Program (CalRHT) does not require matching funds from the County to receive an award for the Family Medicine Obstetrics (FM-OB) grant program that Arrowhead Regional Medical Center (ARMC) applied for under the CalRHT Grant Program.
BACKGROUND INFORMATION
HCAI through CalRHT is developing the FM-OB Fellowship Subaward Program (grant program) as a proposed funding opportunity under the Transformative Care Model (TCM) initiative’s Expand and Support Rural Workforce Capacity Program. The intent of the grant program is to expand access to high-quality maternity and perinatal care in California's rural communities by increasing the number of family physicians with advanced obstetrics training.
Through support for FM-OB fellowship programs and regional collaborative care models, the program builds sustainable obstetric workforce capacity where rural patients receive care, preparing physicians to practice in underserved communities and improving maternal and infant health outcomes.
The grant program is structured as an organizational subaward program administered through a competitive request for application (RFA) process.
On July 15, 2026, HCAI announced the availability of the grant program and RFA process and established an application deadline of August 14, 2026. Following that announcement, ARMC conducted the necessary due diligence to confirm that it could satisfy all application requirements. Because the period between the release of the grant application and the submission deadline did not allow sufficient time to obtain Board of Supervisor (Board) approval before the application was due, ARMC, with the approval of the County Chief Executive Officer (CEO), timely submitted the grant application to preserve the County's eligibility for funding. HCAI does not permit extensions of the application deadline. This is the first available Board meeting following submission of the application, and ARMC respectfully requests approval to ratify the submission of the grant application.
Based on the non-negotiable sample grant agreement provided by HCAI, if the County is awarded the grant, the parties would be required to enter into a grant agreement that includes, among other provisions, the following significant contractual terms:
1. HCAI and the federal government have the right to audit, examine, and copy all records relating to the agreement and to access personnel, facilities, systems, data, and sites for monitoring, audit, investigation, evaluation and closeout.
• The County standard contract does not permit contractors to audit the County's compliance.
• Potential Impact: If an audit determines that the County's use of the grant funds do not comply with the agreement terms, HCAI may demand repayment of the grant funds.
2. The County is required to defend and indemnify HCAI and the State of California from claims that arise out of or are related to the County’s breach of the agreement, misuse of funds, false certifications, negligence, fraud, willful misconduct, violation of law, privacy or security incident, or failure to comply with the grant requirements.
• The County standard contract does not impose an indemnity obligation on the County.
• Potential Impact: In the event a claim arises that falls within the scope of the County’s indemnity obligation, the County may be required to retain attorneys or pay for the cost of defending HCAI and paying any resulting settlement/judgment.
3. In the event that the County owes HCAI a duty of defense under the Agreement, HCAI may choose instead to conduct its own defense at the County’s expense.
• The County standard contract does not impose a contractual duty on the County to pay for the defense of the contractor.
• Potential Impact: In the event that an indemnifiable claim arises against HCAI, HCAI could decide to utilize its own counsel to defend HCAI in the claim and the County would be responsible for reimbursing HCAI for the cost of the defense.
4. Venue is Sacramento, California.
• The County standard contract requires venue for disputes to be in the San Bernardino County Superior Court, San Bernardino District.
• Potential Impact: In the event a dispute arises between the County and HCAI that requires legal intervention, the case must be filed in Sacramento County.
ARMC will develop its FM-OB fellowship capacity through the following activities and services:
• Planning activities for organizations developing a new fellowship, including feasibility assessments, curriculum design, partnership development, and clinical-site development.
• Implementation and expansion activities, including new rural-focused fellowship positions, new rural rotation sites, and faculty and preceptor capacity.
• Regional shared services, supervision pools, and coordination infrastructure that support fellowship sites within a regional care collaborative.
Approval of Recommendation No. 2 will authorize the ARMC CEO, subject to review by County Counsel, to approve and execute a grant agreement with HCAI if the County is selected as a recipient for the grant. This authority is requested because, upon notification of award, HCAI requires recipients to electronically execute and accept the grant agreement within seven business days. Failure to do so may result in HCAI deeming the County to have declined the grant award. If the grant is awarded by HCAI through CalRHT, ARMC will return to the Board for ratification of ARMC CEO’s approval and execution of the grant agreement.
ARMC recommends approval of this item to help support the Family Medicine-Obstetrics and Gynecology program, including faculty effort and preceptor support, administrative and program operations, teaching curriculum and didactic infrastructure, and shared regional services, while expanding current ARMC fellowship programs and strengthening partnerships with our rural community hospitals to ensure availability of critical healthcare services in the county.
PROCUREMENT
Not applicable.
REVIEW BY OTHERS
This item has been reviewed by County Counsel (Anushka Silva, Deputy County Counsel, 387-5473) on August 26, 2026; Risk Management (Stephanie Pacheco, Staff Analyst II, 386-9044) on July 29, 2026; ARMC Finance (Chen Wu, Finance and Budget Officer, 580-3165) on August 10, 2026; County Finance and Administration (Jenny Yang, Administrative Analyst, 387-4884) on August 13, 2026.