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County
Budget Category : HEALTH AND HUMAN SERVICES
Budget Department : HEALTH SERVICES AGENCY
2019-20 Recommended Revenues
* Other includes all segments less than 1% of the total. Negative segments are not shown.
By Budget Division 2019-20 Recommended 2018-19 Adopted Variance from 2018-19 Adopted
ADMINISTRATION
 
$18,416,218
10%
$18,201,572
11%
$214,646
1.2%
CLINICS SERVICES
 
$44,270,284
25%
$39,944,386
24%
$4,325,898
10.8%
PUBLIC HEALTH
 
$15,466,879
9%
$16,524,703
10%
$1,057,824
6.4%
BEHAVORIAL HEALTH
 
$80,917,583
46%
$76,595,465
46%
$4,322,118
5.6%
H.S.A. - HEALTH BENEFITS DIVIS
 
$7,892,213
4%
$7,892,213
5%
$0
0.0%
ENVIRONMENTAL HEALTH
 
$9,131,621
5%
$8,500,514
5%
$631,107
7.4%
Total
 
$176,094,798
100%
$167,658,853
100%
$8,435,945
5.0%
GENERAL SERVICES

CLINICS EXPANSION

The Health Services Agency (HSA) has completed an extensive remodel at the Emeline Clinic to add 14 exam rooms and completed a remodel at the Watsonville Health Center to add four exam rooms. HSA continues to look for opportunities to expand space and services for the Homeless Persons Health Project clinic. The services provided at HSA clinics continue to expand, particularly around Integrated Behavioral Health (IBH) services and Medication Assisted Treatment (MAT) services. IBH services have gone from approximately 2,500 visits in 2015 to close to 10,000 in 2018 and are continuing to climb. MAT case management services increased from almost 0 in 2015 to over 1,200 in 2018 and are also continuing to increase as HSA adds more provider capacity.

BEHAVIOR HEALTH

FIT PILOT

The Focused Intervention Team (FIT) pilot is an initiative to enhance community safety and move into treatment high-frequency criminal offenders funded by Measure G. The FIT Pilot is not an off-the -shelf public safety or behavioral health program, but a hybrid drawing from established law enforcement and behavioral health practices. FIT Pilot clients are connected with a range of wraparound services, including medical and food benefits, housing navigation and more. The program leverages the resources of existing community partners including the newly restarted PACT Court, which also serves as the court for the Homeless Outreach, Proactive Engagement & Services (HOPES) program.

PUBLIC GUARDIAN

The county Public Guardian (PG) office is legally mandated to provide conservatorships to oversee the care and treatment, or to financially manage an estate through probate court, for clients who are gravely disabled. In the last few years, the PG office has experienced a significant increase in the need for conservatorships. In addition, many of HSA's conservatees reside in out-of-County placements, increasing the time needed for the PG Deputies and Social Workers to travel to these placement for visits and case management. HSA has been working collaboratively with the Human Services Department and the hospitals to help support the increased demand for services, as hospitals struggle with arranging safe discharges for adults who lack the capacity to care for themselves. Increasing staffing by 5.0 FTE positions for this program will help decrease ongoing risk of abuse or neglect and increase the level of service for these conservatees who are among the most vulnerable citizens and aging population throughout Santa Cruz County.

DRUG MEDICAL ODS

Drug Medi-Cal Organized Delivery System (DMCODS) is a statewide waiver pilot project to test a new paradigm for the organized delivery of SUD health care services for Medi-Cal-eligible customers. Accomplishments in the first year have allowed HSA to provide an increased range of DMC services and benefits including early intervention, outpatient services, intensive outpatient services, short-term residential treatment, case management, withdrawal management, recovery maintenance services, and physician consultation services. Withdrawal management continues to be a challenging modality for our system, as the County does not have sufficient treatment opportunities to meet the community need. As a result, HSA is seeking creative solutions, such as contracting with an out-of county provider to serve County beneficiaries. While engaged in service expansion efforts, HSA has concurrently partnered with the community to implement cultural shifts to treatment milieus that more thoroughly meet the diverse needs of our beneficiary population. Treatment opportunities are more heavily client-directed under DMC-ODS, with beneficiaries striving towards accomplishment of self-identified goals in episodes of varying length dependent on their medical necessity. This includes shifting criminal justice mandates to indicate compliance with the appropriate level of care determined by the assessment process, as opposed to the historical practice of prescribing a set number of days in a specific level of care. Finally, programs have embraced the harm reduction continuum model, which creates space for all beneficiaries to receive care regardless of their current drug or alcohol use patterns.

ENVIRONMENTAL HEALTH

Environmental Health will be implementing new State requirements for a higher level of oversight of Onsite Wastewater Treatment Systems, requiring a much higher level of data management. This additional work will be facilitated by the addition of a Departmental Administrative Analyst and Administrative Aide, primarily funded through CSA 12, Wastewater Management. There continues to be a high number of sites contaminated by past releases of toxic materials. An additional Resource Planner position will help address the backlog of known sites and identify additional sites through more oversight of soil investigations. This position will be fee-supported. Environmental Health is also partnering to keep county water resources safe and sustainable. A groundwater sustainability study will be completed by December 2020, and the division is working with the Resource Conservation District and other partners to complete additional stormwater capture and recharge projects.

For additional information please see the full budget document.