Title
Adopt a Resolution to:
a. Amend the County of Monterey Health Department’s Behavioral Health Bureau Fiscal Year (FY) 2023-24 Adopted Budget (4000-023-HEA012-8410) to add six (6.0) FTE Social Worker III (SW III) positions, one (1.0) FTE Sr. Secretary position, one (1.0) FTE Sr. Psychiatric Social Worker (Sr. PSW) position, and reallocate one (1.0) FTE Sr. Account Clerk position to one (1.0) FTE Accounting Technician position as indicated in Attachment A, resulting in increased costs of $279,806 in FY 2023-24, and $1,382,055 in FY 2024-25, financed by a corresponding increase in revenue (4/5ths vote required); and
b. Amend the County of Monterey Health Department’s Administration Bureau FY 2023-24 Adopted Budget (4000-001-HEA014-8438) to add seven (7.0) FTE Community Service Aide III (CSA III) positions, two (2.0) FTE Chronic Disease Prevention Coordinator (CDPC) positions, one (1.0) FTE Management Analyst II (MA II) position, one (1.0) FTE Project Manager II position, and one (1.0) FTE Principal Office Assistant (POA) position, as indicated in Attachment A, resulting in increased costs of $399,966 in FY 2023-24, and $1,413,663 in FY 2024-25, financed by a corresponding increase in revenue and charges for services (4/5ths vote required); and
c. Amend the County of Monterey Health Department’s Public Guardian FY 2023-24 Adopted Budget (4000-001-8118-HEA008) to add one (1.0) FTE Deputy Public Guardian/Administrator/Conservator II (Deputy) position as indicated in Attachment A, resulting in increased costs of $43,598 in FY 2023-24, and of $174,391 in FY 2024-25, financed by a corresponding increase in revenue (4/5ths vote required); and
d. Increase appropriations and estimated revenue by $3,958,171 in the County of Monterey Health Department’s Behavioral Health Bureau FY 2023-24 Adopted Budget (4000-023-HEA012-8410) (4/5ths vote required); and
e. Increase appropriations and estimated revenue by $3,310,000 in the County of Monterey Health Department’s Clinic Services Bureau FY 2023-24 Adopted Budget (4000-001-HEA007-8592) (4/5ths vote required); and
f. Authorize and direct the Auditor-Controller, and the County Administrative Office to incorporate these position and appropriations changes in the County of Monterey Health Department’s Behavioral Health Bureau FY 2023-24 Adopted Budget (4000-023-HEA012-8410); and
g. Authorize and direct the Auditor-Controller, and the County Administrative Office to incorporate the position changes in the County of Monterey Health Department’s Administration Bureau FY 2023-24 Adopted Budget (4000-001-HEA014-8438); and
h. Authorize and direct the Auditor-Controller, and the County Administrative Office to incorporate the position changes in the County of Monterey Health Department’s Public Guardian FY 2023-24 Adopted Budget (4000-001-HEA008-8118); and
i. Authorize and direct the Auditor-Controller, and the County Administrative Office to incorporate the appropriations changes in the County of Monterey Health Department’s Clinic Services Bureau FY 2023-24 Adopted Budget (4000-001-HEA007-8592).
Report
RECOMMENDATION:
It is recommended that the Board of Supervisors Adopt a Resolution to:
a. Amend the County of Monterey Health Department’s Behavioral Health Bureau Fiscal Year (FY) 2023-24 Adopted Budget (4000-023-HEA012-8410) to add six (6.0) FTE Social Worker III (SW III) positions, one (1.0) FTE Sr. Secretary position, one (1.0) FTE Sr. Psychiatric Social Worker (Sr. PSW) position, and reallocate one (1.0) FTE Sr. Account Clerk position to one (1.0) FTE Accounting Technician position as indicated in Attachment A, resulting in increased costs of $279,806 in FY 2023-24, and $1,382,055 in FY 2024-25, financed by a corresponding increase in revenue (4/5ths vote required); and
b. Amend the County of Monterey Health Department’s Administration Bureau FY 2023-24 Adopted Budget (4000-001-HEA014-8438) to add seven (7.0) FTE Community Service Aide III (CSA III) positions, two (2.0) FTE Chronic Disease Prevention Coordinator (CDPC) positions, one (1.0) FTE Management Analyst II (MA II) position, one (1.0) FTE Project Manager II position, and one (1.0) FTE Principal Office Assistant (POA) position, as indicated in Attachment A, resulting in increased costs of $399,966 in FY 2023-24, and $1,413,663 in FY 2024-25, financed by a corresponding increase in revenue and charges for services (4/5ths vote required); and
c. Amend the County of Monterey Health Department’s Public Guardian FY 2023-24 Adopted Budget (4000-001-8118-HEA008) to add one (1.0) FTE Deputy Public Guardian/Administrator/Conservator II (Deputy) position as indicated in Attachment A, resulting in increased costs of $43,598 in FY 2023-24, and of $174,391 in FY 2024-25, financed by a corresponding increase in revenue (4/5ths vote required); and
d. Increase appropriations and estimated revenue by $3,958,171 in the County of Monterey Health Department’s Behavioral Health Bureau FY 2023-24 Adopted Budget (4000-023-HEA012-8410) (4/5ths vote required); and
e. Increase appropriations and estimated revenue by $3,310,000 in the County of Monterey Health Department’s Clinic Services Bureau FY 2023-24 Adopted Budget (4000-001-HEA007-8592) (4/5ths vote required); and
f. Authorize and direct the Auditor-Controller, and the County Administrative Office to incorporate these position and appropriations changes in the County of Monterey Health Department’s Behavioral Health Bureau FY 2023-24 Adopted Budget (4000-023-HEA012-8410); and
g. Authorize and direct the Auditor-Controller, and the County Administrative Office to incorporate the position changes in the County of Monterey Health Department’s Administration Bureau FY 2023-24 Adopted Budget (4000-001-HEA014-8438); and
h. Authorize and direct the Auditor-Controller, and the County Administrative Office to incorporate the position changes in the County of Monterey Health Department’s Public Guardian FY 2023-24 Adopted Budget (4000-001-HEA008-8118); and
i. Authorize and direct the Auditor-Controller, and the County Administrative Office to incorporate the appropriations changes in the County of Monterey Health Department’s Clinic Services Bureau FY 2023-24 Adopted Budget (4000-001-HEA007-8592).
SUMMARY/DISCUSSION:
The Health Department (Department) requests the Board of Supervisors (Board) approval to amend its FY 2023-24 Adopted Budget to add and reallocate positions to implement the staffing structure that will meet business needs and perform programmatic activities in the Behavioral Health and Health Administration Bureaus, and the Public Guardian Division, and to increase appropriations in the Behavioral Health and Clinic Services Bureaus to accommodate the anticipated increased financial activity. The requested adjustments will be financed with a mix of Department revenues, including grant funds, direct fund allocations, patient and client fees, Federal Financial Participation, and Realignment.
Since adoption of the FY 2023-24 budget, the Department has successfully competed for grant funds to finance capital needs, increase access to social and medical services through system navigation and linkages, further support the implementation of the California Advancing and Innovating Medi-Cal initiative (CalAIM), and received a direct allocation of Future of Public Health (FoPH) funds, which are intended to bolster public health infrastructure. The new funding and associated programmatic activities necessitated staffing adjustments to align resources with the program activities to be performed. To that end, at the November 17, 2023, Special Meeting, the Department presented the first of two such requests to add and reallocate positions, which the Budget Committee supported, and the Board approved on December 5, 2023. This second request contains the last set of positions needed to complete the staffing structure, and a request to increase budget authority for the anticipated level of activities to be completed through the end of the fiscal year. The need to increase appropriations is due to revenues and expenditures for the new grants not being included in the Department’s FY 2023-24 Adopted Budget.
In the Behavioral Health Bureau, the SW IIIs will provide case management, help facilitate groups, and perform Officer of the Day duties, which will allow licensed staff to focus on clinical care. In addition, SW IIIs will provide linkage to other community resources that will support clients’ recovery and wellness. The Sr. PSW will support the implementation and expansion of integrated mental health and substance use disorder services and will participate in monitoring/oversight activities to ensure compliance with program rules and regulations. The Sr. Secretary will provide administrative support to executive leadership, including managing and coordinating day-today logistics, maintaining calendars and scheduling, etc. The Accounting Technician will perform general accounting tasks, invoice audit and reconciliation, journal, and correcting entries.
In the Health Administration Bureau, the CSA IIIs and CDPC positions will implement the activities of the Go-Biz grant from the Governor’s Office of Business and Economic Development. This program is geared to populations who have been disproportionately impacted by the war on drugs (WoD). Through system navigators, this program aims to assist the eligible population access social and medical care systems, and will assist with job training and employment opportunities, financial literacy support, finding stable housing, and linkage to other supports such as legal services, tattoo removal, etc. The Project Manager II will manage medium-to major capital projects through the various phases of construction or renovation and ensure compliance with all applicable laws, and oversee maintenance programs, since most Health locations are single-use facilities, and as such, the Department is responsible for their upkeep. The MA II and the POA will support the implementation of the PATH CITED grant, which through a needs assessment will identify gaps in capacity for services and implement the Health Information Exchange (HIE)/Community Information Exchange (CIE) project.
In the Public Guardian Division, conservatorship referrals have continued to increase in number and in complexity. In addition, it is anticipated that recent changes in the law which expand the criteria for “gravely disabled” will result in a significant increase of referrals. The new Deputy II will be assigned a caseload of Public Guardian/Administrator cases.
The Clinic Services Bureau requires increased appropriations to accommodate services at new clinic locations, including the Salinas integrated clinic and the mobile clinic. The increased costs will be financed with fees for services.
This recommended action supports the County of Monterey Health Department 2018-2024 Strategic Plan Goal(s): 3) Ensure access to culturally and linguistically appropriate, customer-friendly, quality health services; and 4) Engage Monterey County Health Department workforce and improve operational functions to meet current and developing population health needs.
OTHER AGENCY INVOLVEMENT:
The County of Monterey Administrative Office and Human Resources Department have reviewed and approved the proposed position reallocations and additions. This item was presented to the Budget Committee on January 31, 2024.
FINANCING:
There will be no impact to the Department’s General Fund contribution.
The cost of the additional Behavioral Health Bureau positions is estimated at $279,806 in FY 2023-24 and $1,382,055 in FY 2024-25 and will be financed by a combination of Federal Financial Participation, Realignment, Mental Health Services Act and Opioid Settlement funds. The increased appropriations of $3,958,171 will accommodate the costs of the anticipated grant activities for the remainder of the fiscal year.
Health Administration’s additional costs for the new positions is estimated at $399,966 in FY 2023-24 and $1,413,663 in FY 2024-25 which will be financed by grant revenues and inter-departmental reimbursement.
The additional cost of the new position at the Public Guardian is estimated at $43,598 in FY 2023-24 and $174,391 in FY 2024-25 and will be financed with client fees.
The increased appropriations in the Clinic Services Bureau will be financed with fee for service revenue.
For FY 2024-25 and thereafter, the associated revenue and expenditures of the new positions and grant activities will be part of the Department’s Requested Budget.
BOARD OF SUPERVISORS STRATEGIC INITIATIVES:
Check the related Board of Supervisors Strategic Initiatives:
☐ Economic Development:
• Through collaboration, strengthen economic development to ensure a diversified and healthy economy.
☐ Administration:
• Promote an organization that practices efficient and effective resource management and is recognized for responsiveness, strong customer orientation, accountability, and transparency.
☒ Health & Human Services:
• Improve health and quality of life through County supported policies, programs, and services; promoting access to equitable opportunities for healthy choices and healthy environments in collaboration with communities.
☐ Infrastructure:
• Plan and develop a sustainable, physical infrastructure that improves the quality of life for County residents and supports economic development results.
☐ Public Safety:
• Create a safe environment for people to achieve their potential, leading businesses, and communities to thrive and grow by reducing violent crimes as well as crimes in general.
Prepared by: Miriam Y. Mendoza, Finance Manager, 755-4622
Approved by:
__________________________________Date____________________________
Elsa Mendoza Jimenez, Director of Health Services, 755-4526
Attachment(s):
Board Report
Attachment A - Position Changes
Attachment B - Summary of Changes
Board Resolution