REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
June 9, 2026
FROM
ANDREW GOLDFRACH, ARMC Chief Executive Officer, Arrowhead Regional Medical Center
SHANNON DICUS, Sheriff-Coroner, Sheriff’s Department
SUBJECT
Title
Agreements with the California Department of Health Care Services for the Medi-Cal County Inmate Program
End
RECOMMENDATION(S)
Recommendation
1. Approve non-financial Provider Participation Agreement (State Agreement No. 26-MCIPSANBERNARDINO-36), with the California Department of Health Care Services, for the Medi-Cal County Inmate Program, effective July 1, 2026, until terminated by either party.
2. Approve Administrative Services Agreement, with the California Department of Health Care Services (State Contract No. 26-60138), for reimbursement of administrative costs associated with participation in Medi-Cal County Inmate Program, for an amount not to exceed $70,864.74, for the period of July 1, 2026 through June 30, 2029.
3. Authorize ARMC Chief Executive Officer to execute all future non-substantive amendments that update the Provider Participation Agreement and Administrative Services Agreement, subject to review by County Counsel and the Chief Executive Officer, so long as such amendments do not increase any of the agreement amounts or extend the term of the agreements.
4. Direct ARMC Chief Executive Officer to transmit all non-substantive amendments to the agreements to the Clerk of the Board of Supervisors within 30 days of execution.
(Presenter: Andrew Goldfrach, ARMC Chief Executive Officer, 580-6150)
Body
COUNTY AND CHIEF EXECUTIVE OFFICER GOALS & OBJECTIVES
Operate in a Fiscally-Responsible and Business-Like Manner.
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
Approval of this item will not result in the use of Discretionary General Funding (Net County Cost) as the non-financial Provider Participation Agreement (PPA) will allow the County, through Arrowhead Regional Medical Center (ARMC) and the Sheriff/Coroner/Public Administrator (Sheriff), to continue to contract with the Department of Health Care Services (DHCS) to participate in the Medi-Cal County Inmate Program (MCIP) effective July 1, 2026.
Approval of the Administrative Services Agreement (ASA) will allow the County, through ARMC and Sheriff, to continue to contract with DHCS to receive funding under the MCIP and will enable the County to reimburse DHCS a maximum of $21,830.47 for fiscal year 2026-27, $23,563.80 for fiscal year 2027-28, and $25,470.47 for fiscal year 2028-29. The total reimbursement cost of $70,864.74, is for administrative costs in operating the MCIP program paid by ARMC, however, due to the additional revenue, the administrative cost will be reimbursed.
Additionally, approval of the ASA will allow ARMC to receive an estimated additional annual revenue of $3 million from reimbursements associated with the Federal Financial Participation (FFP) of qualified acute inmate inpatient care provided by ARMC through MCIP. Participation in the MCIP will also allow the Sheriff to reduce the amount the County pays for services provided to certain inmates at non-county facilities, by an estimated amount of $250,000. Adequate appropriation and revenue have been included in ARMC’s 2025-26 budget and will be included in future recommended budgets.
BACKGROUND INFORMATION
The County has participated in the MCIP since July 2018 as approved by the Board of Supervisors (Board) on May 22, 2018 (Item No. 21), September 10, 2019 (Item No. 21), May 19, 2020 (Item No. 21), and more recently April 11, 2023 (Item No. 15).
The MCIP occurs at both a state and County level and allows Medi-Cal coverage for allowable inpatients hospital services to MCIP eligible inmates, including psychiatric and physician services.
ARMC provides inpatient care to inmates incarcerated in correctional facilities throughout the county, as needed. Federal law prohibits claiming Medi-Cal funds for healthcare services provided to inmates residing in correctional facilities. However, there is an exception to this federal law when an inmate, who is found to be Medi-Cal enrolled, receives inpatient services at a medical facility located off the grounds of the correctional facility for an expected stay of more than 24 hours. Payment is dependent on the number of qualified acute patient days.
The MCIP eligible inmate refers to an individual who is eligible to receive MCIP services under the Adult County Inmate Program, Juvenile Ward Program, the County Compassionate Release Program, and the County Medical Probation Program. Under the MCIP, Medi-Cal providers receive federal reimbursement at the applicable Medi-Cal Fee-For-Service (FFS) rate using the same claims process for non-inmate FFS Medi-Cal beneficiaries.
DHCS’s ability to draw federal funds for allowable services, consistent with federal law, allows ARMC to receive reimbursement of expenses for medical care to inmates that would have otherwise been not recoverable. In addition, MCIP allows Sheriff to reduce the amount paid for inpatient services at non-county facilities. The MCIP will only pay the federal share of the Medi-Cal payment.
DHCS requires that entities participating in MCIP enter into both the PPA and the ASA. The PPA allows the County to participate in the DHCS MCIP for California. As part of the PPA, the parties agree to the terms in the ASA, which includes reimbursement to DHCS for the administrative costs of operating the MCIP.
The PPA and ASA (Agreements) are standard DHCS agreements, which include the following non-standard contract terms:
1. The Agreements do not require DHCS to indemnify the County, as required by County Policies 11-05 and 11-07.
• The County standard contract indemnity provision requires the contractor to indemnify, defend, and hold County harmless from third party claims arising out of the acts, errors or omissions of any person.
• Potential Impact: DHCS is not required to defend, indemnify or hold the County harmless from any claims, including indemnification for claims arising from DHCS’s negligent or intentional acts. If the County is sued for any claim based on the agreements, the County may be solely liable for the costs of defense and damages.
2. The Agreements do not require DHCS to meet the County’s insurance standards as required pursuant to County Policies 11-05, 11-07 and 11-07SP.
• County policy requires contractors to carry appropriate insurance at limits and under conditions determined by the County’s Risk Management Department and as set forth in County policy and in the County standard contract.
• Potential Impact: The County has no assurance that DHCS will be financially responsible for claims that may arise under the agreements.
3. The County is required to indemnify, defend, hold harmless DHCS, its officers, employees, and agents from any and all reported expenditures, liability, loss, or expense (including reasonable attorney fees) for injuries or damage to any person, any property, or both which arise out of the terms and conditions of the agreements and the negligent or intentional acts or omissions of the County, its officers, employees, or agents.
• The County standard contract does not include any indemnification or defense by the County of a contractor.
• Potential Impact: By agreeing to indemnify DHCS, the County could be contractually waiving the protection of sovereign immunity. Claims that may otherwise be barred against the County, time limited, or expense limited could be brought against DHCS without such limitations and the County could be responsible to defend and reimburse DHCS for costs, expenses, and damages.
Delegated authority is requested to allow timely execution of future non-substantive amendments required by DHCS to maintain uninterrupted participation in MCIP. ARMC recommends approval of these Agreements, including the non-standard terms, for safety and health needs of all County residents by providing eligible MCIP inmates healthcare services.
PROCUREMENT
Not applicable
REVIEW BY OTHERS
This item has been reviewed by County Counsel (Daniella Hernandez, Deputy County Counsel, 387-5455) on May 14, 2026; Risk Management (Stephanie Pacheco, Staff Analyst II, 386-9030) on May 15, 2026; ARMC Finance (Chen Wu, Finance and Budget Officer, 580-3165) on May 18, 2026; and County Finance and Administration (Erika Rodarte, 387-4919 and Jenny Yang, 387-4884 Administrative Analysts) on May 21, 2026.