To: Board of Supervisors
From: DHHS: Public Health
Agenda Section: Consent
SUBJECT:
title
Grant Agreement with County Medical Service Program for the Local Indigent Care Needs Implementation Grant for the term of July 1, 2022, through June 30, 2025.
end
RECOMMENDATION(S):
Recommendation
That the Board of Supervisors:
1. Approve the grant agreement with the County Medical Services Program (CMSP) in the amount of $1,500,000 for the term of September 1, 2021, through August 31, 2024;
2. Authorize the Director of Public Health, or designee thereof, to sign three (3) originals of the agreement;
3. Authorize the Director of Public Health, or designee thereof, to sign all future amendments and documents directly related to this grant agreement upon review and approval of County Counsel and Risk Management; and
4. Direct the Clerk of the Board to return one (1) copy of the certified board report to the Department of Health and Human Services (DHHS) - Contract Unit
Body
SOURCE OF FUNDING:
Public Health Fund
DISCUSSION:
The Public Health Mobile Outreach Program has a long history of operating and working with community partners in multiple settings and underserved populations since the 1980s. The mobile clinic reaches people in places where vulnerable groups gather including homeless encampments, shelters, free meal programs, low-income housing facilities, substance use residential treatment programs, and traditionally low-income areas such as tribal communities. Additionally, the program provides HIV care coordination and has the skill to expand services to include hepatitis C (HCV) disease management.
Working relationships with community partners such as Waterfront Recovery Services, Aegis, Arcata House, Alcohol Drug Care Services, United Indian Health Services, Open Door (including Mobile Medical), and others are highly established and have been paramount to supporting the target population in accessing enabling services. In addition, Public Health's community partner networks are broad and deep. Public Health has established, organized, and driven many community coalitions and planning groups throughout the years. Currently, Public Health coordinates the Hepatitis C Task Force, the Sexual Health Task Force, the Suicide Prevention Network, Humboldt Allies for Substance Abuse Prevention, as well as the county’s Community Health Assessment and Community Health Implementation Plan. Public Health Outreach also has a lead role in the Overdose Prevention Workgroup and the RxSafeHumboldt Coalition to address overdose and serves on multiple coalitions/workgroups including Humboldt Housing and Homeless Coalition.
DHHS - Public Health will leverage this funding source in conjunction with other related funding sources to enhance services along the continuum of care for persons living with HCV. The results of this program will be mobile client-centered HCV testing throughout Humboldt, enhanced linkages to needed medical care, and HCV treatment, encouraging enhanced communication between DHHS-Public Health, local care agencies, and other local stakeholders. The ultimate desired Public Health outcome is a reduction in the local HCV infection and transmission rates.
Incidence (newly identified HCV cases) for 2019-2021 has decreased by approximately 27% from HCV incidence from 2016-2018. A DHHS - Public Health epidemiologist suggests that HCV intervention efforts by DHHS - Public Health and partners, and the effect of COVID-19 on the health care/surveillance systems are the main reasons for the decrease in new cases. However, there is no way of knowing which of these has had the greatest effect.
The project’s overall approach (leveraging access to the target population and key partnerships with Open Door Community Health Centers, Aegis Methadone Clinic, and Waterfront Recovery), is to support the target population in accessing HCV treatment. The target population includes adults in Humboldt County who are experiencing complex health conditions, specifically HCV, that are compounded by health inequity through high-risk substance use behaviors, many of whom are experiencing homelessness, and transportation challenges.
Public Health will improve disease management by expanding rapid HCV testing to the target population with two mobile clinics; providing HCV Care Coordination to assist with appointments, insurance, transportation, medication adherence, and reinfection prevention counseling; partnering and contracting with Open Door to provide HCV treatment and a data sharing agreement; and partnering with Aegis Treatment Center’s methadone clinic and Waterfront Recovery Services to provide HCV testing on-site and direct referrals to the Care Coordinators.
The CMSP Local Indigent Care Needs (LICN) Implementation Grant, Humboldt County will add 2.5 FTE Health Education Specialists, Care Coordinators, 0.5 FTE of a Senior Health Education Specialist, and supporting staff to address the gaps in the system of care coordination and low barrier access to HCV treatment. Funds will also support computer equipment and HIV/HCV/STI test counseling certifications for new staff, mileage and maintenance costs for the two mobile vans to provide weekly testing services to substance use disorder (SUD) treatment facilities and various locations in Humboldt County including areas with high prevalence (eastern and southern Humboldt) and other office supplies, client incentives, and data systems costs for project evaluation.
Anticipated outcomes and deliverables of this project are:
• 2,400 individuals from the target population will be reached through the mobile clinic each year.
• 1,560 rapid HCV tests will be administered over the project period.
• 60% of those who test positive will get a confirmatory test.
• 60% of those who are referred for treatment will be linked to medical care.
• 70% of those who enter treatment will complete it.
• 10% reduction in the HCV rate of new infections.
• 20% reduction in the need for repeat treatment due to reinfection.
This agreement is coming to your Board after the start date of the contract due to delays in the contracting process with the granting agency.
FINANCIAL IMPACT:
Approval of this grant with CMSP allows DHHS - Public Health to be reimbursed a maximum of $1,500,000 in fund 1175, Budget Unit 437002 - Hepatitis C High Risk Program for the period of July 1, 2022, through June 30, 2025. A supplemental budget will be submitted after the adoption of the county Fiscal Year (FY) F2022-23 budget to supplement Fund 1175, Budget Unit 437002, Hepatitis C High Risk Program in the amount of $500,000 for the period of July 1, 2022, to June 30, 2023. $500,000 will be incorporated into the county budget process for FY 2023-24, and $500,000 will be incorporated into the FY 2024-25 budget. There is no impact to the County general fund.
STRATEGIC FRAMEWORK:
This action supports your Board’s Strategic Framework by creating opportunities for improved safety and health, providing community-appropriate levels of service, and protecting vulnerable populations.
OTHER AGENCY INVOLVEMENT:
Open Door Community Health Centers
Aegis Treatment Center
Waterfront Recovery Services
ALTERNATIVES TO STAFF RECOMMENDATIONS:
Your Board may choose not to approve the recommendations; however, it would result in a loss of both funding and services to the County.
ATTACHMENTS:
Grant Agreement with CMSP for the LICN Implementation Grant
PREVIOUS ACTION/REFERRAL:
Board Order No.: C-10
Meeting of: 7/14/2020
File No.: 20-819