Special Notice / Hearing: None__
Vote Required: Majority
To: Honorable Board of Supervisors
From: Colleen Chawla, Chief, San Mateo County Health
Jei Africa, Director, Behavioral Health and Recovery Services
Subject: Authorizing the Chief of San Mateo County Health or Designee to Execute Agreements with Essential Local Community-Based Organizations for Board and Care Services
RECOMMENDATION:
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Adopt a resolution authorizing the Chief of San Mateo County Health or designee(s) to execute agreements and negotiate amendments with each contractor listed in Attachment A to provide board and care services, for the term of July 1, 2026 through June 30, 2029 in an aggregate amount not to exceed $3,170,000.
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BACKGROUND:
Since 1985, this Board has approved resolutions authorizing expenditures for residential board and care (B&C) facilities serving clients with severe mental illness by providing residential care services. These facilities serve a critical role in supporting Behavioral Health and Recovery Services (BHRS) clients by providing long-term placements and care for a population of clients that are often stigmatized and perceived as having too many complex issues.
B&C facilities provide essential services, including meals, assistance with daily living activities, medication support, and social skills development. In-County placement allows clients to remain connected to their families, friends, and communities. The alternative - out-of-County B&C placement - would be more costly and disrupt these support networks.
In recent years, the County B&C market has declined. Several established providers have retired or closed operations, and few new operators have entered the field. Efforts by BHRS to engage additional County-based providers have been unsuccessful, largely due to limited financial incentives and the complexity of serving this population.
As a result, over the past year alone, BHRS has lost two more in-County contracted B&C facilities, reducing the capacity by another 12 beds. Given the specialized essential needs of this population and limited provider pool, the County has adopted a targeted procurement approach, in addition to the B-1 Administrative Memorandum exception for Housing Services and Related Supports.
DISCUSSION:
Attachment A identifies seven contractors that operate B&C facilities and outlines the contract amounts for each contractor. Approval of the recommended resolution will authorize the Chief of San Mateo Health, or designee(s), to execute agreements and associated amendments with the contractors listed in Attachment A for a total aggregate amount not to exceed $3,170,000.
All seven local contractors operate B&C facilities and provide enhanced services for individuals with serious mental illness who require intensive support services. These services are essential to maintaining clients living in the community in the least restrictive level of care.
Pursuant to the B-1 Administrative Memorandum, the selection of these seven local contractors for the provision of residential services for mental health clients is exempt from the Request for Proposals requirement.
The resolution contains the County’s standard provision allowing amendment of the County’s fiscal obligations by a maximum of $25,000 (in aggregate).
The agreements and resolution have been reviewed and approved by the County Attorney as to form.
It is anticipated that 100% of B&C clients will remain in an acute level of care.
PERFORMANCE MEASURE:
|
Measure |
FY 2025-26 Estimated |
FY 2026-27 Projected |
|
Percentage of B&C clients that remain in an acute level of care |
100% 60 clients |
100% 60 clients |
COMMUNITY IMPACT:
These agreements will positively impact a critically underserved community of BHRS clients who have severe mental illness and will benefit from a secured placement to support their stabilization and recovery. These B&C providers are vital placement resources for such individuals. These agreements with the B&C providers afford these individuals an ability to step down from more acute, more costly levels of care to a placement that can address their behavioral health needs. These providers are committed to serving this population and supporting them with achieving their recovery goals.
FISCAL IMPACT:
The term of all the agreements is July 1, 2026 through June 30, 2029. The total amount of the agreements is not to exceed $3,170,000 in aggregate for the three-year term. Funds in the amount of $1,056,667 will be included in the BHRS FY 2026-27 Recommended Budget. Of that amount, it is anticipated that $338,133, or 32%, will be funded by the Mental Health Services Act; $644,567, or 61%, will be funded by 1991 Realignment; and $73,967, or 7%, will be funded by Net County Cost.
Similar arrangements will be made for future years. The payment provisions and levels of service in the agreements are essentially the same as the prior agreements.