July 25, 2023 — Madera County Board of Supervisors
Documented by Josef Sibala
Here’s what you need to know
- During its meeting, the Madera County Board of Supervisors directed staff to return on Aug. 1 to allow the appropriation of $500,000 for the Madera Community Hospital after a potential provider’s letter of intent and consultations with the county attorney are made.
- Behavioral Health Director Connie Moreno-Peraza announced that the county had been awarded $25 million of two conditional grants to build a crisis stabilization unit for youth and adults.
- According to Robert Milkin from Force 10 Partners, the re-opening of Madera Community Hospital as an independent hospital does not yield long-term sustainable income or year-over-year positive cash flows.
- Andrea Uribe from Leadership Counsel mentioned that the Community Development Block Grant application of $3.25 million is an opportunity to fulfill the needs of residents in La Viña and Fairmead. She suggested street lighting across La Viña and the crosswalk in Fairmead Elementary School, speed bumps and sidewalks.
Follow-up questions
- What will happen with the Madera Community Hospital?
- Will residents in La Viña and Fairmead benefit from Community Development Block Grant funds?
- How will residents benefit from the $25 million grant awarded to the Behavioral Health Department?
The Scene
According to its website, the Madera County Board of Supervisors is the Madera County government’s legislative and executive governing body. Each of the five supervisorial districts of the county elects one supervisor.
Within limits prescribed by state law, the board enacts ordinances and rules, determines county policy, supervises the activities of county departments, adopts an annual budget, and fixes salaries.
The board meets regularly on the first three Tuesdays of each month and occasionally on Mondays in the board chambers of the County Government Center in Madera. The meeting was held on July 25, 2023, at 9 a.m.
Madera County Board of Supervisors members present:
- Chair David Rogers (District 2)
- Chair Pro Tem Robert Poythress (District 3)
- Jordan Wamhoff (District 1)
- Robert Macaulay (District #5)
Madera County Board of Supervisors member not present:
- Leticia Gonzalez (District 4)
Others Present:
- Chief Clerk Karen Scrivner
- County Counsel Regina Garza
- Deputy County Administrative Officer Joey Bugay
- City Manager Arnoldo Rodriguez
- Behavioral Health Director Connie Moreno-Peraza
- Director of Native Solutions Family Guidance Center Lisa Parker
- Jared Carter from Public Works
- Robert Milkin from Force 10 Partners
- Jamie Bax from Community and Economic Development
- Andrea Uribe from Leadership Counsel
Discussions/Actions
Moreno-Peraza announced that the county had been awarded $25 million of two conditional grants to build a crisis stabilization unit for the youth and adults center.
She said the county also received a conditional grant award for behavioral health housing of close to $3 million.
Director of Native Solutions Family Guidance Center Lisa Parker said their organization was awarded $675,000 for the Evidence Speaks Program.
Carter from Public Works said the county is 70% along in collecting data regarding pavement conditions.
The board (4-0) unanimously approved items A to N from the consent agenda:
A. The board approved the regular meeting minutes for July 18.
B. Madera County Behavioral Health Board Appointments.
1. The board re-appointed Steven Mortimer to the Behavioral Health Board as a District 3 representative for a three-year term ending July 1, 2026.
2. The board re-appointed Donald Horal to the Behavioral Health Board as a District 3 representative for a three-year term ending July 1, 2026.
3. The board reappointed Ginger Prentice to the Behavioral Health Board as a District 5 representative for a three-year term ending July 1, 2026.
C. 9788: The board OK’d an agreement with United Health Services, Inc. (UHS) of Madera, Inc in amounts noted on the rate sheet for the provision of psychiatric inpatient services for children, adolescents, and adults for a term ending June 30, 2024.
D. 9789: The board made an agreement with Relias LLC yearly, for at most $30,853, for Learning Management System access for employees to continue education courses for fiscal years 2023-2026.
E. 9822: The board approved an agreement with Jonathan Terry, DO, at $300 per hour for justice-involved psychiatric and forensic services for the fiscal year 2023-2024.
F. 9819: The board approved an agreement with Madera County Workforce Investment Corporation not to exceed $198,125 for realignment services for the Sheriff’s Office-Jail Division for the fiscal years 2023-2026.
G. 9812: The board OK’d an agreement with Verkada Inc. via ConvergeOne, Inc. for at most $105,772 for purchasing and installing a surveillance system in the Madera County Justice Center.
H. 9813: The board accepted the monthly report of employee transactions for June 2023.
I. 9824: Madera/Chowchilla RCD Appointments.
1. The board appointed Shannon Iest to the Madera Resource Conservation District Board of Directors, replacing Tom Petrucci, for a four-year term expiring July 25, 2027.
2. The board appointed Andrew Carroll to the Madera Resource Conservation District Board of Directors, replacing Jay Bellach, for a four-year term expiring July 25, 2027.
J. 9791: The board approved an agreement with Native Solutions Family Guidance Center in amounts as listed in the Program Proposal for counseling services for the fiscal year 2023-2024
K. 9821: The board OK’d an agreement with Madera County Workforce Investment Corporation not to exceed $212,542 for realignment youth services for fiscal years 2023-2026.
L. 9794: The board approved an agreement with the California Department of Health Care Services to participate in the Rate Year 2021 Voluntary Rate Range Intergovernmental Transfer Program for local Medi-Cal managed care providers Blue Cross of California Partnership Plan and CalViva Health for January 2021 through June 2024.
M. 9817: The board entered into an agreement with Evident Change in an amount not to exceed $24,980 for a child welfare reporting service identified as Evident Change Internet Reporting Service, referred to as SafeMeasures, a subscription service that allows customers to monitor and access reports for the fiscal years 2023-2025.
N. 9814: The board entered into an agreement with the State of California Department of Health Care Services in an amount that shall not exceed $10,703 over three years for the reimbursement of administrative costs for the Medi-Cal Inmate Program Agreement for fiscal years 2023-2026
Discussion items were acted on as follows:
6.a. 9820: The board (4-0) adopted a resolution approving an application and participation in the Behavioral Health Continuum Infrastructure Program (BHCIP) Round 5 Crisis and Behavioral Health Continuum grant project.
Moreno-Peraza said that the California Department of Health Care Services (DHCS), through its contractor, Advocates for Human Potential, Inc. (AHP), has issued a request for applications, dated Jan. 31, 2022 (RFA), for the Behavioral Health Continuum Infrastructure Program.
BHCIP was established to construct, acquire and rehabilitate real estate assets or to invest in needed mobile crisis infrastructure to expand the community continuum of behavioral health treatment resources.
DHCS has issued the RFA for Program grant funds under Welfare and Institutions Code Sections 5960-5960.45.
Program grant funds are derived primarily from the federal Coronavirus State and Local Fiscal Recover Funds, established by the American Rescue Plan Act of 2021, and partly from the State of California General Fund.
Madera County, through its Department of Behavioral Health Services (MCDBHS), applied for Program grant funds. After review and consideration, MCDBHS has been identified as a conditional awardee of program funds from the Department of Health Care Services (DHCS).
6.b. 9825: Public Works Department/Engineering Services Division
1. The board (4-0) approved Amendment MCC No. 11255B-21 with HDR Engineering, Inc. for Solid Waste Management Consulting Services to revise the scope and compensation and extend the term to Feb. 29, 2024.
2. The board (4-0) authorized the auditor-controller to issue payments for contingencies up to 10% of the amended agreement amount per established county policy.
3. The board (4-0) assigned the chief of development services or their designee to solely issue and approve Contract Change Orders under the Contract Code, not to exceed authorized 10% contingencies.
4. The board (4-0) issued a request for qualifications/request for proposals for solid waste management consulting services following the expiration date of Feb, 29, 2024.
According to Carter, the requested amendment includes increasing the compensation for fiscal year 2022-23 by $41,526 for additional services performed, and assistance from HDR Engineering related to SB 1383 implementation and initiating the comprehensive Solid Waste Management Study.
The county anticipated that HDR Engineering’s services would continue to be needed for this effort, along with the continuation of the previously provided Solid Waste Management Consulting services tasks.
The Public Works Department is requesting to amend the contract with HDR to account for the continuation of these services as follows:
• Extend the term of the contract to expire on Feb. 29, 2024 (approximately eight months).
• Amend the scope of services and compensation for $151,092 for services from July 1, 2023, through Feb. 29, 2024.
6.c. 9859: The board received the presentation and updated with Force 10 Partners consultants of “Madera Community Hospital Historical Volumes, Profitability & Re-Opening Analysis.”
According to Milkin from Force 10 Partners, the re-opening of Madera Community Hospital as an independent hospital would not yield long-term sustainable income or year-over-year positive cash flows.
He suggested that Madera Community Hospital’s best chance for a sustainable future is sponsoring an organized health system, which has substantial leverage, and multiple health system contracts from payers.
He said that qualifying for a $30 million award from the Distressed Hospital Loan Program (DHLP) can assist in assuring the successful re-opening of MCH under another organization’s sponsorship.
He stressed that local future management must be extremely competent in expense management.
He added that rebuilding the local physician and clinic networks is paramount to successfully achieving any level of the conservatively projected volumes.
He mentioned that future management must also be experienced in driving significant improvements in all payor contracts and government reimbursement programs.
In any scenario, he said that DHLP funds are assumed to be a grant and may not be repaid.
The re-opening of MCH as a System Affiliated hospital can result in the potential of increased revenues totaling $32.3 million and increased operating expenses totaling $23.6 million for an improved net income operating margin of $55.5 million over five years.
Hw estimated a six- to nine-month ramp-up to doors open, costing approximately $15 million once a decision is made to reopen and a System Affiliated Operator is signed.
Facility capital needs a total additional estimate of $10 million. Additional working capital needs a total of $30 million.
Delays in opening have significant financial implications for reimbursement for Medicare and the Hospital Fee Program.
Milkin shared that only one operator is interested, qualified, and ready to fund the re-opening of MCH.
CEO Karen Paolinelli of MCH informed the board through a letter that the hospital is losing $500,000 monthly to maintain essential plant operations.
Keeping the plant operational allows for health care services in the county in the future.
Paolinelli asks that from July 30 to Aug. 30, the county assist as the hospital waits for a decision by the state regarding the Distressed Hospitals Loan Program.
Rogers clarified that having the county acquire the hospital was never his intent. He said that the goal is ensuring medical needs are met through an outside institution.
Through the closure, he shared his concern about the community being unserved. He shared a story of his close friend’s mother, who arrived at St. Agnes Hospital and saw the hallway full.
Wamhoff added that he is leery of providing bridge money for a high burn rate without a real plan, yet reopening the hospital is a priority.
Milkin suggested the county consult with bankruptcy attorneys regarding the Distressed Hospitals Loan Program.
Bugay suggested the board direct staff to return on Aug. 1 to appropriate $500,000, and disbursement can only be made once the county receives a letter of intent from a potential provider to the hospital.
The board (4-0) directed staff to return to the hospital on August 1 to appropriate $500,000 for disbursement after a potential provider’s letter of intent and consulting with the county attorney.
The public hearings consisted of the following:
7.a. 9816: State Community Development Block Grant and 2023 Notice of Funding Availability.
1. The board held a hearing to accept comments on the county’s proposed application submittal to apply under the 2023 State Community Development Block Grant (CDBG) Notice of Funding Availability and solicited citizen input.
2. The board (4-0) adopted a resolution approving an application for funding and the execution of a grant agreement and any amendments from the 2023-2024 funding year of the State Community Development Block Grant Program.
Bax said the grant total is $3.25 million. The application period will open at the end of August. She emphasized the need for shovel-ready projects.
Uribe mentioned that the Community Development Block Grant application of $3.25 million is an opportunity to fulfill the needs of residents in La Viña and Fairmead.
She suggested street lighting across La Viña and the crosswalk in Fairmead Elementary School, speedbump, and sidewalks. She urged for greater outreach.
Closed sessions were as follows:
2.a. 9823: Request for closed session:
Government Code Section 54957.6
Conference with labor negotiators
Agency designated representatives: Human Resources Director Roman Noriega, Deputy County Administrative Officer-Finance Joel Bugay, and Human Resources Manager Susan Carter
Employee organization: all units
Unrepresented employees: all classifications (excluding elected officials)
2.b. 9810: Request for closed session:
Government Code Section 54956.9 (d)(1)
Conference with legal counsel – existing litigation
Name of case: In re: Madera Community Hospital, Debtor in Possession. (United States Bankruptcy Court, Eastern District of California, Fresno Division; Case Number 23-10457-A-11
The meeting lasted until 1 p.m. The next board meeting will be on August 1 at 9 a.m.
If you believe anything in these notes is inaccurate, please email us at Fresnodocs@fresnoland.org with “Correction Request” in the subject line.