Special Notice / Hearing: None__
Vote Required: Majority
To: Honorable Board of Supervisors
From: Colleen Chawla, Chief, San Mateo County Health
Michael del Rosario, Director, Correctional Health Services
Subject: Authorizing the Controller to Pay Non-Contract Medical Service Providers at Non-County Facilities to Provide Services to County Incarcerated Persons
RECOMMENDATION:
title
Adopt a resolution authorizing the Controller to pay non-contract medical service providers at non-County facilities to provide services to County incarcerated persons not available at a County site for the term of June 9, 2026 to December 31, 2026, in an amount not to exceed $450,000.
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BACKGROUND:
Since 1980, this Board has authorized the Controller to pay non-contract medical service providers at non-County facilities to provide services to County incarcerated persons when San Mateo Medical Center or a contracted medical care provider is unable to provide the necessary level of care.
Specific to Correctional Health Services (CHS), California Assembly Bill 658 (AB658), enacted on July 16, 2015, authorizes hospitals that do not contract with the county sheriff’s police chief or other public agency to provide emergency health care services to local law enforcement patients at a rate equal to 110 percent of the hospital’s actual costs, according to the most recent Hospital Annual Financial Data report issued by the Office of Statewide Health Planning and Development, as calculated using a cost-to-charge ratio.
In January 2026, this Board approved a resolution authorizing the Controller to pay non-contract medical service providers at non-County facilities to provide services to County incarcerated persons not available at a County site for the term of January 6, 2026, to December 31, 2026, in an amount not to exceed $542,500.
DISCUSSION:
In recent years, CHS’s outside hospital costs have significantly increased for a number of reasons. As a result of criminal justice realignment and changes in sentencing laws, incarcerated persons are staying in correctional facilities longer, requiring more medical care for which the County is financially responsible. Related to these longer stays, CHS is seeing an increase in patient acuity requiring treatment for cancer diagnoses, complications due to strokes, and other neurological conditions. Additionally, trauma services are required for emergency services, such as falls or chest pain complaints. (CHS notes that of the $396,349 in outside hospital expenses since January 2026, 58% or $229,882 is for emergency, trauma, and operational services).
As a result of these multiple factors, CHS’ annual costs for outside hospital care - in accordance with AB658 billing rates - has risen from $420,000 to $620,000 per year within the last three years. While the Medi-Cal County Inmate Program has allowed outside providers to claim Medi-Cal reimbursement for inpatient costs (i.e., lowering the responsible amount for CHS), outpatient costs - including emergency and trauma services - are still not reimbursable, resulting in a balance authorized under the current resolution of $146,151.
|
Current Resolution Approved |
Outside Hospital Expenses |
Authorized Balance Remaining ($542,500 maximum) |
|
January 2026 |
$396,349 |
$146,151 |
Due to these factors, CHS continues to have a need to access non-contract, non-County medical service providers. CHS is working with the County Attorney’s Office to negotiate hospital services contracts with such medical service providers in the coming year. To continue to meet the needs of such CHS patients in the interim, CHS requests that this Board authorize the payment of non-contract medical service providers at non-County facilities when medically necessary and adopt a new resolution to increase payment of these services for a six-month term effective June 9, 2026, through December 31, 2026. The resolution has been reviewed and approved by the County Attorney as to form.
It is anticipated that less than 10% of CHS patients will be referred to non-contract medical service providers for specialty care services.
PERFORMANCE MEASURE:
|
Measure |
FY 2025-26 Estimated |
FY 2026-27 Projected |
|
Percentage of patients referred to non-contract medical services providers for specialty care services |
<10% <100 patients |
<10% <100 patients |
COMMUNITY IMPACT:
Services provided by this resolution will positively impact the physical and emotional well-being of incarcerated people who identify or treat conditions not previously addressed. These services will further reduce unnecessary emergency admissions and inpatient hospitalizations during incarceration as well as upon community reentry. Individual and public health outcomes are improved from medical care received in a compassionate, culturally and linguistically appropriate, and timely manner.
FISCAL IMPACT:
The term of this agreement is June 9, 2026, through December 31, 2026. The total authorized expenditures under the resolution are not to exceed $450,000 for the six-month term. Inmate medical costs are funded by a combination of Health Realignment funds, Net County Cost and Medi-Cal. The cost of outside hospital services is included in the FY 2025-26 Approved Budget and will be included in the FY 2026-27 budget.