HomeMy WebLinkAboutfy-04-05-report-final
Measure A
Essential Health Care Services Tax Ordinance
Oversight Committee
1st Annual Report
to the Alameda County Board of Supervisors and to the Public
(Review of Fiscal Year 2004/2005 Expenditures)
TABLE OF CONTENTS
Page
Measure A Oversight Committee Members…………………………………………………………….. 3
Executive Summary………………………………………………………………………………………………………….. 4
Section 1 – State of Health Care…………………………………………………………………………………. 6
Section 2 – Funding Allocation and Review Process…………………………………………… 8
Section 3 – How the Money was Spent………………………………………………………………. 9
• Review of Fiscal Year 04/05 Expenditures – Alameda County Medical Center…………… 10
• Review of Fiscal Year 04/05 Expenditures – 25% Measure A Funds Allocated by the
Alameda County Board of Supervisors…………………………………………………………………………. 11
• School-Based Health Center (SBHC) Coalition……………………………………………………………… 12
• Primary Care Community-Based Organization (CBO) Clinics………………………………………. 13
• Private and Non-Profit Hospitals……………………………………………………………………………………. 15
• Emergency Room (ER) and On-Call Physician Compensation……………………………………… 16
• Alameda County Public Health Department – Prevention Initiative……………………………. 16
• Alameda County Behavioral Health Department – Community-Based Organization
(CBO) Contract Providers………………………………………………………………………………………………. 17
• Detoxification / Sober Station Update………………………………………………………………………….. 18
Section 4 – Highlights……………………………………………………………………………………………………… 19
Section 5 – Areas of Concern………………………………………………………………………………………… 22
Section 6 – Oversight Committee Information….………………………………….………………. 23
Section 7 – For More Information.…………………………………………………………………………….. 24
Appendix
• Appendix A – Measure A Revenue Received in FY 04/05…………………………………………….. 26
• Appendix B – FY 04/05 Measure A Fund Distribution by Provider or Program…………… 27
• Appendix C – Detoxification / Sober Station Update………………………………………….………… 32
• Appendix D – Maps: Geographic Distribution of Providers Receiving Measure A
Funds in FY 04/05…………………………..……………………………………………………….
33
1) School-Based Health Centers………………………………………………………………. 34
2) Primary Care Community-Based Organization Clinics………………………… 35
3) County, Private and/or Non-Profit Hospitals and
Alameda County Public Health Department Programs…………………………
36
4) Emergency Rooms where ER and On-Call Physicians Provided
Service……………………………………………………………………………………………….….
37
5) Alameda County Behavioral Health Department –
Alcohol and Drug Treatment Service Providers……………………………………
38
6) Alameda County Behavioral Health Department –
Adult and Children Mental Health Service Providers……………………………
39
MEASURE A OVERSIGHT COMMITTEE MEMBERS
Committee Member Representing / Nominated By:
Rich Ambrose City Managers’ Association
Adele Amodeo* Supervisorial District 5
Ken Ballard League of Women Voters
Louis Chicoine Supervisorial District 1
Bradley Cleveland Central Labor Council of Alameda County
Kay Eisenhower Supervisorial District 4
Jay Garfinkle, M.D. Alameda Contra Costa Medical Association
Arthur Geen Alameda County Taxpayers Association
Peter Manoleas, LCSW City of Berkeley
Neil Marks Hospital Council of Northern California
Larry J. Platt, M.D. Alameda County Public Health Commission
Beth Pollard City Managers’ Association
Charlie Ridgell Central Labor Council of Alameda County
Don Sheppard Supervisorial District 2
Ron Silva Supervisorial District 3
Ronald Tauber Alameda County Mental Health Board
Sal Tedesco League of Women Voters
*Adele Amodeo’s appointment effective beginning January 2007.
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EXECUTIVE SUMMARY
In March 2004 Alameda County voters approved Measure A, the Essential Health Care Services
Initiative. Measure A authorized the County of Alameda to raise its sales tax by one-half cent in
order to “provide for additional financial support for emergency medical, hospital inpatient,
outpatient, public health, mental health and substance abuse services to indigent, low-income,
and uninsured adults, children, families, seniors and other residents of Alameda County.”
One of the provisions of Measure A was the establishment of a Citizen Oversight Committee. The
role of the Oversight Committee is to annually review Measure A expenditures for each fiscal year
and report to the Board of Supervisors on the conformity of such expenditures to the purposes
set forth in the Measure. This is the Measure A Oversight Committee’s first annual report and is a
review of fiscal year (FY) 04/05 expenditures.
In fiscal year 04/05, Measure A generated a total of $95,674,783. Seventy-five percent
($71,756,087) of the total funds were allocated directly to the Alameda County Medical Center
(ACMC). The Alameda County Board of Supervisors was responsible for allocating the remaining
25 percent (see Appendix A: Measure A Revenue Received).
Following the passage of Measure A, the Alameda County Board of Supervisors approved 3-year
funding allocations totaling $20 million to the following:
1) Alameda County Public Health Prevention Initiative;
2) Emergency Room and On-Call Physician Compensation;
3) Alameda County Behavioral Health Care Community Based Organization Providers;
4) Alameda County Detoxification / Sober Station;
5) Primary Care Community Based Organization Primary Care Clinics;
6) Private and District Hospitals;
7) School-Based Health Centers; and
8) Health Insurance Expansion and Board of Supervisors Discretionary Allocation.
In fiscal year 04/05, funding allocations were spent in six of the eight areas listed above. These
included the Alameda County public health prevention initiative, emergency room and on-call
physician compensation, Alameda County behavioral health care community-based organization
providers, primary care community-based organization primary care clinics, private and district
hospitals and school-based health centers. Of the $20 million allocated by the Board,
approximately $14 million was spent in fiscal year 04/05. Of the remaining $6 million,
approximately $2.9 million was approved to roll into fiscal year 05/06 to be expended in the same
manner as originally designated. Of the remaining $3.1 million, $2.8 million was designated for
building improvements, major equipment purchase and some program expansion in fiscal year
05/06.
Measure A funds were largely used to sustain existing health services. ACMC was able to
continue to offer a full continuum of care for the county’s indigent and low-income residents.
Measure A funds also helped to maintain services at St. Rose and Children’s Hospitals.
Emergency rooms remained open and adequately staffed to meet the needs of county residents.
Six percent of the Alameda County behavioral health care community-based organization provider
personnel was restored as a result of Measure A.
Measure A funds also allowed for expansion of some services including those provided by the
primary care community-based organization clinics and the school-based health centers in east
and south Alameda County. The Alameda County Public Health Department expanded service in
the areas of diabetes, dental care for children, school-wide chronic disease prevention campaigns,
nutrition, and school nursing in the Oakland Public School District.
The Measure A Oversight Committee determined that funds that were spent in fiscal year 04/05
and reviewed by the Committee were in compliance with the purposes set forth in Measure A.
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The Committee found inconsistencies in the way information was reported which did not allow
consistent scrutiny of all fund recipients. The Committee will work on refining the review process
that encourages greater consistency and detail of reports by all fund recipients.
Other concerns raised by the Oversight Committee include the composition of the Committee, a
better understanding of the quality control of County and Health Care Services Agency auditing
mechanisms and the process for determining future allocations by the Board of Supervisors.
SECTION 1 – STATE OF HEALTH CARE
Alameda County’s Measure A was put before the voters in March 2004 at a time when the state’s
health care system was in crisis. Publicly supported services in primary care, hospital care, public
health and behavioral health were facing sharply increasing costs with inadequate resources.
Although Measure A has helped to substantially ease this crisis, there is still much work to be
done.
The Alameda County Medical Center (ACMC), the county’s network of three public hospitals and
three outpatient clinics, faced a $50 million deficit. In June 2003, ACMC was forced to cut 100
employees and shut two clinics, displacing 15,000 patients, thereby putting a strain on an already
strained primary care network in the county. ACMC and the state’s other public hospitals were
“on the brink of collapse," according to the California Association of Public Hospitals (CAPH).1 The
public health care safety-net confronted shrinking revenue, even as demand for healthcare
services by an increasing number of uninsured and underinsured patients continued to grow.
CAPH concluded the crisis would worsen as “the unstable patchwork” of federal, state and local
funds, on which public hospitals are dependent, continued to shrink:
• The federal government was cutting funding for Medi-Cal, the primary revenue stream for
ACMC, as well as community clinics and behavioral health services for the uninsured;
• California was facing a $30 billion budget shortfall;
• Alameda County had a $98.4 million deficit in FY 04/05, following a $112.6 million deficit
in FY 03/04.
To cope with the growing health care crisis, CAPH urged policymakers to “maintain current levels
of funding . . . and target new funds to the public health care safety net for care of low-income
and uninsured Californians.”
The year 2003 also saw the publication of a report by the
State of California’s Little Hoover Commission.2 This report
found that California, along with other states, was struggling
to pursue longstanding priorities with diminished resources,
while at the same time grappling with new demands to
protect and serve its residents. The public health system,
the report noted, is central to this struggle. A strong public
health system can reduce injury, illness and death. But
California’s public health infrastructure was found to be in
poor repair. The report concluded, “There is a nexus
between traditional public health and the crisis over health
care. Effective public health programs can efficiently help to
maintain the health of all Californians and reduce the
demand on the clinics and emergency rooms.”
“We are truly facing a crisis in our
community. Nine out of ten kids with
substance abuse problems do not
receive treatment. Our network of
providers in Alameda County is
underfunded and understaffed. We
need to fortify our fledgling system so
we can deliver addiction treatment
services to our kids.”
Tom Gerstel
Thunder Road, Fremont
Testimony from Public Hearing 2004
In response to the crisis in health care, the Alameda County Board of Supervisors, working with
health care providers and advocates and community representatives, drafted Measure A. The
supervisors voted unanimously in December 2003 to put the initiative on the March 2004 ballot.
With two-thirds of county voters approving the measure, the county would increase its sales tax
by one-half cent and dedicate these funds “to provide and maintain trauma and emergency
medical services throughout Alameda County, and to provide primary, preventative and mental
health services to indigent, low-income and uninsured children, families and seniors. . .” The
initiative further stipulated that 75 percent of funds generated would be earmarked for ACMC and
1 “On the Brink: How the Crisis in California’s Public Hospitals Threatens Access to Care for Millions;”
California Association of Public Hospitals and Health Systems, 2003. 2 “To Protect & Prevent: Rebuilding California's Public Health System,” Report of the Little Hoover
Commission, State of California, April 2003
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allocation of the remaining 25 percent of the funds (not specifically designated for ACMC) would
be determined by the Alameda County Board of Supervisors.
Throughout the county, voters adopted the measure by over 70 percent. The county began to
collect the sales tax revenue in July, 2004. The additional half-cent sales tax generated over $95
million in its first year, fiscal year 2004/2005 (see Appendix A: Measure A Revenue Received).
The Measure thus allowed the level of health services to be maintained for the period that this
report addresses, and, in some cases, to be increased and improved all across the county, and
the financial condition of ACMC to be stabilized.
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SECTION 2 – FUNDING ALLOCATION AND REVIEW PROCESS
Following the passage of Measure A, the Alameda County Board of Supervisors authorized
Alameda County Health Care Services Agency (HCSA) to work with Board staff to hold 10 public
hearings throughout the county with the express purpose of soliciting recommendations regarding
the distribution of the 25 percent allocation not specifically designated for ACMC.
An estimated 800 to 900 attended the public hearings. Upon completion of the hearings, HCSA
worked closely with Board staff to draft recommendations regarding the allocation of funds and
the authorization needed for implementation. On December 14, 2004, the Board approved three-
year funding allocations in eight general categories:
1) Alameda County Public Health Prevention Initiative;
2) Emergency Room and On-Call Physician Compensation;
3) Alameda County Behavioral Health Care Community-Based Organization Providers;
4) Alameda County Detoxification / Sober Station;
5) Primary Care Community-Based Organization Primary Care Clinics;
6) Private and District Hospitals;
7) School-Based Health Centers;
8) Health Insurance Expansion and Board of Supervisors Discretionary Allocation.
In addition to determining the allocation of funds not specifically designated for ACMC, the Board
of Supervisors is responsible for reviewing and approving all Measure A contracts. The board is
also charged with the task of establishing the Measure A Oversight Committee and approved the
following composition of the Oversight Committee:
• 2 representatives from the League of Women Voters reflecting both north and south / east
county;
• 1 representative from the Alameda County’s Taxpayer Association;
• 1 representative from the Alameda County Mental Health Advisory Board;
• 1 representative from the Public Health Advisory Board;
• 2 representatives from SEIU;
• 1 representative from the East Bay Hospital Council Staff;
• 1 representative from the Alameda Contra Costa Medical Association;
• 2 representatives chosen by the City Managers Association;
• 1 representative from the City of Berkeley;
• 1 representative from the Tri-Valley Area;
• 1 representative each from the 5 Supervisory Districts selected by respective Board
member; and
• Staff support provided by Health Care Services Agency.
The establishment of the Committee occurred late in 2005. Most members were officially
appointed in November 2005 and began meeting in December 2005.
SECTION 3 – HOW THE MONEY WAS SPENT
Seventy-five percent of funds generated by Measure A are allocated to the Alameda County
Medical Center (ACMC) Board of Trustees, while the remaining 25 percent is allocated by the
Alameda County Board of Supervisors.
Figure 1
Distribution of Measure A Funds
75%
25%
Alameda County Medical
Center Board of Trustees
Allocation by Board ofSupervisors
In fiscal year 04/05 Measure A generated $95,674,783. The following sections provide more
detail on the allocation and expenditure of those funds. See Appendix B for the fund distribution
by provider or program for the 25 percent allocation by the Board of Supervisors. See Appendix
D for maps demonstrating the geographic distribution of providers receiving Measure A Funds.
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Review of Fiscal Year (FY) 04/05 Expenditures - Alameda County Medical Center
Figure 2
Alameda County Medical Center
Net Operating Budget
18%
82%
Measure A Revenue
Non-Measure ARevenue
ACMC reports the continuation or
expansion of programs including:
• Continued operation of the
Critical Care and Clinic
Building on the Highland
campus; • Improving the quality of
emergency care and
expanding access to
outpatient services; • Initiation of perinatology
services for mothers facing
high-risk births; • Introduction of rapid HIV
testing in the emergency
room and a palliative care
initiative to address chronic pain management;
• Physician training in internal
medicine, general and oral surgery, emergency medicine and primary care;
• Sexual assault and rape crisis
programs; • Injury prevention and
substance abuse prevention
programs;
• Breast, cervical and prostate cancer programs; and
• Chronic disease management
and health education, focusing on diabetes, asthma
and congestive heart failure.
In fiscal year 04/05, ACMC received a total of $71,756,087 in Measure
A revenue. For fiscal year 04/05, Measure A revenue represented
approximately 18 percent of ACMC’s net operating revenue budget of
$392,450,000.
FY 04/05 Allocation: $71,756,087
Amount Expended / Encumbered: $71,756,087
The Alameda County Medical Center receives 75 percent of all Measure
A revenue to support its network of three hospitals—Highland in
Oakland, and Fairmont and John George Psychiatric Pavilion in San
Leandro—and four satellite clinics — Eastmont Wellness in Oakland,
Juvenile Hall in San Leandro, Winton Wellness in Hayward and Newark
Health Center in Newark.
Medi-Cal, Medicare and Alameda County reimburse ACMC at a rate that is below its actual costs.
Measure A revenue fills ACMC’s “funding gap.” Unlike these other funding sources, Measure A
revenue will increase over time, as sales tax revenue grows, allowing ACMC to better cope with
the escalating costs of health care.
ACMC was able to fulfill its mission as the county’s primary health safety-net provider, and to
continue to offer a full continuum of care for the county’s indigent and low-income residents.
Relative to hospital services, ACMC accounts for over half of all indigent, uncompensated and
charity care provided in the county. These medical services included:
• Primary and specialty outpatient care;
• Inpatient medical, surgical, labor and delivery, rehabilitation and psychiatric care;
• Trauma Center, medical and psychiatric emergency care;
• Imaging, laboratory, pharmacy and other related medical services;
• Medical social work, discharge planning and financial eligibility for public insurance
programs;
• Long term care.
The remaining (less than) 50 percent of hospital services for this population are provided by a
combination of eight hospitals.
After a decline in inpatient and outpatient services in recent years, ACMC was able to stabilize the
volume of services, providing 115,000 inpatient days, and 270,000 clinic visits. In addition, ACMC
served about 235 patients per day in its emergency rooms.
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Review of Fiscal Year (FY) 04/05 Expenditures - 25% Measure A Funds Allocated by the
Alameda County Board of Supervisors
In FY 04/05, the 25 percent of Measure A revenue allocated by the Board of Supervisors was
budgeted at $20 million and allocated as follows:
Figure 3
FY 04/05 Measure A Funding Allocations
Allocated by Board of Supervisors
School-Based Health
Clinics, $1,000,000
Health Insurance
Expansion, $250,000
Alameda County
Public Health
Department -
Prevention Initiative,
$3,000,000 Emergency Room
and On-Call
Physician
Compensation,
$1,500,000
Alameda County
Behavioral Health
Care Department -
CBO Provider
Contracts,
$2,250,000
Primary Care CBOs,
$5,000,000 Detoxification
Program, $2,000,000
Private and Non-
Profit Hospitals,
$4,500,000
Board of Supervisors
(discretionary
allocation), $500,000
Due to the timing of the passage of Measure A, the expenditure of most funds did not occur until
late in fiscal year 04/05. Approximately $5.9 million of the budgeted revenue was not spent in
that fiscal year. Of the $5.9 million, $2.86 million was approved to roll into fiscal year 05/06
Measure A allocations to be expended in the same manner as originally designated (see Figure 4
below). Of the remaining $3.1 million, approximately $2.6 million was designated for building
improvements and major equipment purchases. The remaining unspent $.5 million was spent in
fiscal year 05/06.
Figure 4
Department 04/05
Allocation Expended Encumbered Unspent –
to be reallocated
Unspent –
to roll forward
Public Health (PH)
PH Prevention Initiative $3,000,000 $315,696 $42,340 $2,641,964 $0
ER & On-Call Physician Compensation $1,500,000 $1,350,000 $0 $0 $150,000
Behavioral Health
CBO Providers $2,250,000 $2,234,675 $15,325 $0 $0
Detoxification / Sober Station $2,000,000 $0 $0 $0 $2,000,000
Admin / Indigent Health
Primary Care CBOs $5,000,000 $4,522,826 $477,174 $0 $0
Private and Non-profit Hospitals $4,500,000 $4,500,000 $0 $0 $0
School-Based Health Clinics $1,000,000 $541,608 $0 $248,393 $210,000
Health Insurance Expansion $250,000 $0 $0 $250,000 $0
Board of Supervisors
Districts 1-5 $500,000 $0 $0 $0 $500,000
TOTAL $20,000,000 $13,464,805 $534,839 $3,140,357 $2,860,000
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(Funds designated as “roll forward” were not spent in fiscal year 04/05 by a specific department /
program and were authorized to be rolled into fiscal year 05/06 to be used by the same
department / program.)
The Oversight Committee focused its review of expenditures only on those that were actually
spent in fiscal year 04/05. In addition to the review of the ACMC, the following departments /
programs were reviewed:
• School-Based Health Center Coalition;
• Primary Care Community-Based Organization (CBO) Clinics;
• Private and Non-Profit Hospitals;
• Alameda County Public Health Department – Emergency Room and On-Call Physician
Reimbursement;
• Alameda County Public Health Department – Prevention Initiative;
• Alameda County Behavioral Health Care Department –CBO Contract Providers
School-Based Health Center (SBHC) Coalition
FY 04/05 Measure A Allocation: $1,000,000 “School-based health care is a critical
part of the adolescent health care
safety net in Alameda County. Beyond
the basic services, these programs
deliver preventative care and mental
health services.”
Cindy Burnett
Alameda County
School-Based Health Center Coalition
Testimony from Public Hearing, 2004
Amount Expended / Encumbered: $541,608
The mission of the School-Based Health Center Coalition is
to improve the health, well-being, and success of
adolescents in school by increasing access to comprehensive
and high quality health care services, reducing barriers to
learning and supporting families and communities through
an integrated service delivery model that provides basic
medical care, mental health services and health education in
a respectful, teen-centered environment.
SBHC Funding Used for:
• Maintaining existing services for 11 SBHCs;
• Service Expansion to
reach Fremont and the Tri-Valley region; and
• Service System
Coordination.
Results Noted:
• Increase in number of
SBHC visits by 4%; • Increase in number of
students served by 3%;
• Increase in mental health
visits by 43%; • Use of $1.5 million in
Measure A and Tobacco
Master Settlement funds
($.5 million of which was Measure A funding) to
obtain $6.5 million in total
revenue for the SBHC.
Measure A funding was
used to help support school-based
health centers at the following locations:
School City
Oakland TechniClinic Oakland
James Logan Health Center Union City
Berkeley High Health Center Berkeley
Tri-High Health Services Alameda
Fremont High Tiger Clinic Oakland
San Lorenzo High Health Center San Lorenzo
Roosevelt Health Center Oakland
Tennyson Health Center Hayward
McClymonds Health Center Oakland
Youth Uprising Health Center Oakland
Alameda Health Center Alameda
Encinal Health Center Alameda
The school-based health clinics in Alameda County achieved a
significant increase in their medical, mental health, and health
education services by using $.5 million of Measure A revenue and $1 million from Tobacco Master
Settlement revenue to draw down $6.5 million in state and federal matching funds. The eleven
school health centers in northern and central county region expanded clinic visits by 22 percent
and mental health services by 43 percent. The School-Based Health Center Coalition formed a
partnership with the City of Fremont and area school districts to promote adolescent health.
Working with the cities of Dublin, Livermore and Pleasanton, the coalition established a Youth
Planning Board and the Tri–Valley Adolescent Health initiative to assess the health care needs of
area youth and enhance services to meet these needs.
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Figure 5
School-Based Health Centers
Leveraged* Funding
$1,500,000
$6,500,000
$0
$1,000,000
$2,000,000
$3,000,000
$4,000,000
$5,000,000
$6,000,000
$7,000,000
SBHC
Measure A + Tobacco
Master Settlement Funds
Amount Leveraged
*See page 20 for detailed description of leveraging funds.
Primary Care Community-Based Organization (CBO) Clinics
FY 04/05 Measure A Allocation: $5,000,000
Amount Expended / Encumbered: $5,000,000
Figure 6
Primary Care Clinics Funding Distribution
Life Long Medical Care,
$712,341
Native American Health
Center, $321,859
West Oakland Health Center,
$480,636
Tiburcio Vasquez Health
Center, $525,643
Tri-City Health Center,
$515,642
La Clinica de la Raza,
$1,051,147
Axis Community Health
Center, $420,626
Asian Health Services,
$726,093
Bay Area Consortium for
Quality Health Care*,
$246,013
*Bay Area Consortium for Quality Health Care is not a part of the Alameda Health Consortium. All other clinics
listed above are.
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Funding Used For:
Alameda Health Consortium Clinics
The Alameda Health Consortium comprises eight community health
centers that operate nearly 25 clinic sites in all areas of Alameda
County and are an integral part of the health safety-net.
Alameda Health Consortium
Funding used for:
• Maintaining existing services;
• Funding for clinics that
had historically been a part of the County’s
Medically Indigent
Services Plan (CMSP)
Network; • Expansion of primary
care services to the
uninsured; and
• Investment in the community-based
organization (CBO)
primary care system and infrastructure in Alameda
County.
Results Noted: • 22% increase in CMSP
visits;
• 17% increase in unduplicated patients; • Clinic expansion;
• New equipment;
• Improved health outcomes.
The Alameda Health Consortium distributed its Measure A allocation of
$4,750,000 to its eight-member community clinics in order to
maintain and expand access to services to uninsured and indigent
county residents. The eight non-profit clinics—Asian Health Services,
Axis Community Health, La Clinica de La Raza, LifeLong Medical Care,
Native American Health Center, Tiburcio Vasquez Health Center, Tri–
City Health Center, and West Oakland Health Council—operate 25
sites that serve 115,000 patients each year, 87 percent of whom are
low income. Half of this patient population is uninsured, and 52
percent speak a primary language other than English.
The clinics successfully
leveraged its Measure A
funding to garner additional
state, federal and foundation
funding. The consortium
clinics, which provide
primary care, dental care,
and mental health services,
used Measure A funds to
“Twenty-two years ago, as a much
younger single parent, I didn’t have
medical insurance. Twenty-two years ago I
discovered that I had cancer. Today, I
stand before you a survivor, a survivor
only because I had medical care at a local
neighborhood clinic. I’m not asking, I’m
begging you, to give the community clinics
the funding they desperately need to keep
the rest of the people around here alive.”
Yolanda Trianna
Patient at Tiburcio Vasquez Health Center
Testimony from Public Hearing, 2004
increase patient visits by
22 percent, expand clinic facilities to serve the growing
uninsured population and purchase new medical
equipment. The clinics’ chronic disease management and
health education programs resulted in improved health
outcomes for its diabetic and asthmatic patients and
fewer hospitalizations.
Bay Area Consortium for Quality Health Care
The mission of the Bay Area Consortium for Quality Health Care, Inc.
(BACQHC) is to enhance and sustain the quality of life in communities
by working to ensure access to quality health care. BACQHC strives to
develop aggressive and coordinated outreach, prevention and primary
care services to many of the district’s most vulnerable and least
served residents.
Bay Area Consortium for Quality Health Care
Funding Used For:
• Maintain existing services; and
• Service expansion.
Results Noted: • 6% increase in client
visits in the County’s
Medically Indigent Services Plan (CMSP);
• 50% decrease in number
of no-shows.
The Bay Area Consortium for Quality Health Care, which operates
Berkeley Health Center for Women and Men, received $246,000 in
Measure A funds to expand access to health care for uninsured and
indigent residents of Berkeley and Oakland. The nonprofit
organization also implemented a program to assist patients who
experience problems making their scheduled appointments, which
resulted in a 50 percent decline in “no-shows.”
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Private and Non-Profit Hospitals
FY 04/05 Measure A Allocation: $4,500,000 split between St. Rose and Children’s Hospital
Oakland - $2,250,000 to St. Rose Hospital, $2,250,000 to Children’s Hospital Oakland
Amount Expended / Encumbered: $4,500,000
St. Rose Hospital
St. Rose Hospital in Hayward is an acute, general, not-for-profit,
175-bed facility which serves the needs of southern Alameda County
and its vicinity. St. Rose Hospital provides primary and secondary
medical/surgical services and skilled nursing care while networking
with others to ensure continuity for tertiary care and other needs.
St. Rose Hospital
Funding Used For:
• Maintain existing services;
• Service expansion (county-designated cardiac
receiving center and
expansion of Silva Pediatric
Clinic).
Results Noted:
• Measure A allocation used as a “match” to generate
additional funds.
St. Rose Hospital serves as a health safety-net provider in which 65
percent of ER services are provided to low-income patients. Its Silva
Pediatric Clinic and affiliates serve 15,000 children annually.
St. Rose Hospital used its $2.25 million in Measure A revenue and
$1.8 million in federal matching funds to expand services for low
income residents in its service area. The private, nonprofit hospital
increased pediatric visits to the Silva Clinic. The funding also helped
St. Rose maintain its emergency department, which treats mostly
uninsured and low-income patients and enhanced its cardiovascular
services. Figure 7
St. Rose Hospital Use of Measure A Funding to
Obtain Federal Matching Funds
$2,250,000
$1,800,000
$0
$500,000
$1,000,000
$1,500,000
$2,000,000
$2,500,000
Measure A Allocation
Federal Match
Children’s Hospital Funding
Used For:
• Maintain existing services; • Improvement and expansion
of patient services;
• Improving the hospital’s
bottom line in 2005 from a $4 million annual loss to a $1
million gain;
• Expansion of school-based
programs.
Results Noted:
• Funding used as “match” to raise at least 50% in
additional funds to allow
continuation of programs
slated for elimination.
Children’s Hospital Oakland
Children’s Hospital Oakland serves as a health safety-net for east
Bay children and as a regional pediatric medical center with
specialized staff and facilities able to treat rare illnesses and health
problems. Children’s provides high quality pediatric care for all
children through regional primary and subspecialty networks, its
physician teaching program, and its research and child advocacy
programs.
Children’s Hospital of Oakland increased the impact of its $2.25
million in Measure A revenue by obtaining an additional $1.8 million
in federal matching funds to support its medical services. The
hospital used these funds to support its regional trauma center and
emergency department, which disproportionately serve children from
low-income families. It focused on early intervention and treatment
of behavioral and developmental problems, while expanding primary
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and preventive care at its facilities and at its two school-based clinics.
Figure 8
Children's Hospital Use of Measure A Funding to
Obtain Federal Matching Funds
$2,250,000
$1,800,000
$0
$500,000
$1,000,000
$1,500,000
$2,000,000
$2,500,000
Measure A Allocation
Federal Match
Emergency Room (ER) and On-Call Physician Compensation
FY 04-05 Measure A Allocation: $1,500,000 Results Noted:
Measure A funds allowed
emergency rooms to remain open and adequately staffed to
meet the needs of
county residents.
Amount Expended / Encumbered: $1,350,000
The Alameda County Health Care Services Agency spent $1.35 million to
partially compensate physicians working in area emergency rooms who
provided care to indigent and uninsured patients. Hospital emergency
rooms are required by law to treat all patients needing urgent care, but
doctors only receive partial payment, if any, for emergency services
rendered to these patients.
Measure A helps to fill a funding gap created by state and federal policy. Funding for emergency
care provided by physicians decreased significantly in 1983 when the California Legislature
transferred financial responsibility for providing care to indigent adults from the state to the
counties. Payments to private physicians for emergency care for these patients disappeared
rapidly. In addition, the state fails to fully reimburse physicians who treat patients with Medi-Cal,
the public insurance program available to some low income families.
Alameda County Public Health Department – Prevention Initiative Alameda County
Public Health
Department
Funding Used For:
Maintaining existing services and service
expansion focusing on:
• Chronic disease and injury prevention;
• Health disparities and
community capacity
building; and • Obesity prevention
and school health.
FY 04-05 Measure A Allocation: $3,000,000
Amount Expended / Encumbered: $358,036
The Alameda County Public Health Department consists of an array of
programs and services designed to protect the health and safety of
Alameda County residents. The backbone of Public Health includes
assessments of the health status of residents, disease prevention and
control, community mobilization and outreach, policy development,
education and assurance of access to quality medical and health care
services.
The Alameda County Public Health Department worked with its Advisory
Board to develop a “Public Health Prevention Initiative " targeting three
priority areas:
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1. Chronic Disease and Injury Prevention;
2. Health Disparities and Community Capacity Building; and
3. Obesity Prevention and School Health.
The department only spent $358,036 of its $3 million allocation because the process of engaging
the community and developing these priorities took additional time.
In the area of chronic disease and injury prevention, Project New Start worked with former gang
members to reduce youth violence and offer job training. Asthma Start and the Diabetes Program
taught patients strategies to manage these chronic diseases. Healthy Kids, Healthy Teeth
provided dental services to low income children ages 0-5.
In the area of health disparities and community capacity building, the department worked with
neighborhood groups in Oakland, South Hayward and Livermore to identify leaders to promote
health initiatives in their communities. For example, the Pipeline Project and Health Career
Development Institute provided career development training, counseling, mentoring and paid
summer internships in order to increase the number of underrepresented minority health
professionals working in Alameda County.
In the areas of obesity prevention and school health, the Healthy Living Councils and School
Nursing Partnership worked to promote good nutrition and physical activity and provided health
education in the schools.
Alameda County Behavioral Health Care Department – Community Based Organization
(CBO) Contract Providers
FY 04-05 Measure A Allocation: $2,250,000
Amount Expended / Encumbered: $2,250,000 Funding Used For:
• Maintain existing services for
community-based
organizations (CBOs) by restoring
6% of CBO
personnel;
• Restoration of 60,000 units of
service to 2000
clients.
The mission of the Alameda County Behavioral Health Care Department is
to provide a comprehensive network of integrated programs and services
for all people with serious psychiatric disabilities, regardless of age,
ethnicity, language or geographic location. Funds are used in order to
minimize hospitalization, stabilize and manage psychiatric symptoms and
help achieve the highest possible level of successful functioning in their
community of choice. Funds are also used to provide mental health crisis
and recovery services following major disasters, and to improve the quality
of prevention, treatment and rehabilitation services in order to reduce
illness, death, disability and cost to society resulting from substance abuse.
The Alameda County Behavioral Health Care Department worked with its network of community-
based providers of mental health and substance abuse services to establish priorities for its
Measure A allocation of $2.25 million. The advisory committee set two goals:
1. Restore mental health and substance abuse services that had been eliminated due to
budget cuts to 2,000 clients; and
2. Maintain a broad array of community treatment options by funding prevention services
that had lost funding.
Based on these priorities, the department allocated funding to over 80 nonprofit and for-profit
services providers throughout Alameda County, with $550,000 going to substance abuse
programs and $1,700,000 going to mental health programs. 70 percent of providers within the
Behavioral Health Care Department are community-based organization (CBO) contract providers.
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Detoxification / Sober Station Update
In FY 04/05, $2 million was allocated for detoxification services. While none of the allocated
funds were spent in the first fiscal year, the social model residential detox facility is scheduled to
open in June 2007. A social model is characterized by 24-hour supervision, observation and
support service in a residential setting provided by trained staff. This model emphasizes peer and
social support with the availability of medical assistance, but not onsite. The Alameda County
Board of Supervisors authorized the rollover of unspent funds allocated for the detoxification /
sober station to support the construction of the new facility (see Appendix D: Detoxification /
Sober Station Update).
SECTION 4 – HIGHLIGHTS
Stabilization and Expansion of Services
Measure A expenditures (not designated for the Alameda County Medical Center) in FY 04/05
totaled approximately $14 million, of which approximately $11 million was used to maintain
existing services and approximately $3 million was used for expansion of services:
Figure 9
Total Expended & Encumbered Maintaining Existing Services
Expansion of
Services
Alameda County Public Health $358,036 $0 $358,036
School-Based Health Centers $541,608 $333,215 $208,393
Primary Care Clinics $5,000,000 $2,500,000 $2,500,000
Private and Non-Profit Hospitals $4,500,000 $4,500,000 $0
Emergency Room and On-Call Physician
Reimbursement $1,350,000 $1,350,000 $0
Alameda County Behavioral Health CBO
Providers $2,250,000 $2,250,000 $0
TOTAL $13,999,644 $10,820,000 $3,179,644
Figure 10
FY 04/05 Measure A Use of Funds
$0
$500,000
$1,000,000
$1,500,000
$2,000,000
$2,500,000
$3,000,000
$3,500,000
$4,000,000
$4,500,000
$5,000,000
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Expansion ofServices
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Increased Access to Health Services
The school-based health centers and primary care clinics reported an increase in access to health
services:
Figure 11
# of Increased Visits in FY 04/05 # of Additional Patients Seen in FY 04/05
School Based Health Centers 807 167
Primary Care Clinics 12,660 2,045
Additional Funds Generated
Five million dollars in Measure A funds (allocated to the School-Based Health Center Coalition
(SBHC), St. Rose Hospital and Children’s Hospital Oakland) and $1 million in Tobacco Master
Settlement Funds (designated for SBHC) generated an additional $8,600,000 through leveraging
or federal matching funds:
Figure 12
Total Leveraging or Matching Funds (FY 04/05)
$6,000,000
$8,600,000
$0
$1,000,000
$2,000,000
$3,000,000
$4,000,000
$5,000,000
$6,000,000
$7,000,000
$8,000,000
$9,000,000
$10,000,000
Measure A / TMSF
Amount Leveraged
St. Rose and Children’s Hospital received Measure A funds as a “DSH” (pronounced “dish”)
hospital which means it serves a disproportionate share of low-income, indigent and/or Medi-Cal
patients. DSH status is determined annually by the State based on federal criteria. Measure A
funds allocated to each hospital were used to generate additional funds through matching.
Matching refers to the county's ability to utilize funds to fulfill the State obligation under Medi-Cal
to "match" federal funds at a 50/50 ratio. The County/Health Care Services Agency utilized the
authority within the State/Federal Hospital Financing Waiver, to transfer $4.5 million of Measure A
funds to the State, which was then utilized to draw down on the federal share and return to the
two hospitals via a Medi-Cal contract amendment, at a total guaranteed amount of no less than
150 percent. Both hospitals were able to realize an additional 80 percent of funding.
The School-Based Health Center Coalition (SBHC) was able to generate additional funds through
leveraging. When funding is leveraged, the county provides a funding base (usually $100,000 per
SBHC site) that is utilized to establish a clinic foundation based on specific (Federally Qualified
Health Center Status and Mental Health Early Periodic Screening, Diagnostic and Treatment)
Medi-Cal funding authority, plus school district in-kind and direct funding, to build a full-service
program. In this way, a combined initial investment from the county (Tobacco $1 million plus
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Measure A of $.5 million in FY 04/05) can generate a program commitment four to six times the
initial investment (dependent upon percentage of Medi-Cal youth at the school site).
Addressing Health Disparities
In addition to assuring access to health care for
the county’s indigent, low income and
uninsured residents, the county Public Health
Department works with health care providers,
community agencies, churches, schools,
businesses and others to address patterns of
illnesses and chronic diseases, known as
“health disparities.” For example:
“Alameda County has the second highest rate of
hospitalization due to asthma in California. And
most of these dangerous and costly hospitalizations
can be prevented. More troubling, we know that
certain ethnic and racial groups suffer
disproportionately from asthma and chronic
conditions. For example, African Americans are
hospitalized due to asthma three to four times more
often than their white counterparts and die from the
disease four to five times more often.”
Ann Kelsey Lamb
Regional Asthma Management Prevention Initiative
Testimony from Public Hearing, 2004
• Low income neighborhoods are often
located near freeways, factories and other
sources of pollution. As a result families
experience a higher than average rate of
asthma and other respiratory illnesses;
• There are fewer stores selling fresh fruits
and vegetables in these neighborhoods,
but plenty of fast food restaurants. There
are fewer opportunities for sports and recreation. As a result, many of these neighborhoods
experience a high rate of diabetes, obesity, and heart disease; and
• Substandard housing often suffers from infestation of mice and cockroaches. Leaking roofs
cause mold and mildew to develop. Families in these units suffer from asthma at a higher
rate than the general public.
While it is important to treat the diseases that result from these environmental factors, the Public
Health Department also develops initiatives designed to reduce these health disparities. Other
programs funded by Measure A bring together community-based organizations and neighborhood
leaders to improve access to healthy food, recreational space and other important health
amenities.
Alameda Health Consortium Chronic Disease Management Programs
Similar to the Public Health Department, the Alameda Health Consortium member clinics work to
address the county’s racial and ethnic health disparities through innovative clinical programs that
provide preventive care and chronic disease management for uninsured and underserved
populations. The diabetes and asthma programs have made a significant impact on improving
the health status of clinic patients.
Measure A funding allows the community clinics to expand these efforts to address racial and
ethnic health disparities, which have resulted in measurable improvements in patients’ health
status:
• On average, 90% of AHC clinics’ diabetic patients had one or more sugar blood tests
(HbA1C Test) within one year, and 87% of clinic asthmatic patients were on clinically
appropriate controller medications, with no significant differences by race/ethnicity or
insurance status. These positive outcomes are significantly better than state and national
averages;
• Approximately 3,500 clinic diabetes patients are in computerized diabetes registries that
track and monitor quality of care and health outcomes of the patients.
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22 of 40
SECTION 5 – AREAS OF CONCERN
Reporting Compliance
The Committee hopes to see an improvement in reporting compliance from recipients of Measure
A funds so that they more clearly account for how these funds were spent in accordance with the
language of the measure. Specifically, the information provided by the private hospitals, Alameda
County Medical Center, and the Bay Area Consortium for Quality Health Care did not give as
much detail as necessary to verify compliance.
With respect to the county medical center, the committee needed more information to determine
whether Measure A's prohibition against "supplantation" of ongoing Alameda County funding
provided to ACMC by the new sales tax receipts was being honored. Measure A was very clear
that the new tax revenue was not supposed to substitute for ongoing county funding but was
supposed to supplement the county contribution to ACMC.
The Committee will work on developing a reporting format that encourages a consistent and
detailed report of information by all Measure A recipients, including, where appropriate, a
discussion of how health disparities are addressed.
Quality Control of Alameda County Health Care Services Agency Auditing Mechanisms
The Committee would like information regarding Alameda County and Health Care Services
Agency’s auditing mechanisms with respect to contract monitoring and compliance.
Composition of Committee
The Committee is concerned that the appointed members do not reflect the diversity of Alameda
County’s population and recommends to the Board of Supervisors to take this into account when
the next round of appointments occur.
There is some concern as well that there is a potential for the appearance of conflict of interest
with some appointees representing recipients of Measure A Funds.
Future Allocations
The Committee requests of the Board of Supervisors that changes in future allocations of Measure
A funds be more transparent to the public and to the affected recipients. In the second year of
the distribution of Measure A funds to non-Medical Center providers, a change from the original
percentage allocation to a flat dollar allocation occurred approximately six months after the
Board's initial motion. This change in policy was not explicitly noted on the Board agenda, nor
were affected providers notified. As a result, Measure A tax receipts were carried over from one
year to the next. The Committee believes that such changes should be subject to greater public
debate.
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SECTION 6 – OVERSIGHT COMMITTEE INFORMATION
Organization / Staffing of Committee
The Measure A Oversight Committee currently consists of 17 members representing various
entities in Alameda County. Nominating agencies were formally approved by the Alameda County
Board of Supervisors in January 2005. Formal appointment of most members occurred in
November 2005.
The chair of the Oversight Committee is Dr. Larry J. Platt, representing the Alameda County
Public Health Commission. The vice-chair is Mr. Sal Tedesco representing the League of Women
Voters.
The Oversight Committee is staffed by Dave Kears, Director of Alameda County Health Care
Services Agency; Vana Chavez, Finance Director of Alameda County Health Care Services Agency;
and Jennifer Chan, Measure A Financial Manager, Alameda County Health Care Services Agency.
Regular attendees include staff from the offices of the Alameda County Board of Supervisors, the
Alameda County Auditor’s Office and County Administrator’s Office.
Role / Purpose
As stated in the Measure A ballot measure:
The Citizen Oversight Committee shall annually review the expenditure of the Essential Health
Care Services Tax Fund for the prior year and shall report to the Board of Supervisors on the
conformity of such expenditures of the purposes set forth in Paragraph 2.08.241.
The purposes set forth in Paragraph 2.08.241 are:
A. Proceeds from this tax shall be deposited into the County Treasury in a special fund
entitled “Essential Health Care Services Tax Fund” (hereinafter, the “Fund”).
B. Monies deposited into the Fund, together with any interest that accrues, thereon, shall be
used exclusively for emergency medical, hospital inpatient, outpatient, public health and
mental health care services to indigent, low-income and uninsured adults, children and
families and seniors of Alameda County, as described below in this Paragraph 2.08.241.
C. In each year during the term of this Ordinance, seventy-five percent (75%) of the revenue
generated from this tax shall be transferred to the Medical Center to be used in the
discretion of the governing board of the Medical Center for current and future obligations
of the Alameda County Medical Center (hereinafter, the “ACMC”) provided that:
1. Proceeds from this portion of revenue from this tax may not be used to replace the
funding currently provided by the County to the ACMC pursuant to the existing indigent
care contract between the County and ACMC.
2. If in any year during the term of this Ordinance the County shall be required to reduce
budgetary expenditures due to reductions in discretionary revenue, including, but not
limited to property taxes, motor vehicle license fees and sales and use taxes, or
reductions in health care funding sources, then any resulting reductions in County
funding of the ACMC shall be proportionate to reductions in funding of all other health
care programs provided by the County. The distribution of revenue from this tax shall
not be altered from the allocations set forth in Paragraph 2.08.241C and 2.08.241D
due to reductions in County discretionary revenue or for any other reason.
D. In each year during the term of this Ordinance, the remaining twenty-five percent (25%)
of revenue from this tax shall be allocated by the Board of Supervisors based on the
demonstrated need and the County’s commitment to a geographically dispersed network
of providers, for any of the following purposes:
1. For critical medical services provided by community-based health care providers
2. To partially offset uncompensated care costs for emergency care and related hospital
admissions.
3. For essential public health, mental health and substance abuse services provided.
Meeting Structure
Due to the late establishment of the Measure A Oversight Committee, the Committee held its first
meeting in December 2005. At that time, Measure A was already in its second fiscal year (FY
05/06) of generating funds. Thus the Committee decided to meet monthly in order to complete
the review of expenditures for FY 04/05 as quickly as possible.
The first three meetings were preparatory in nature and included an overview of Measure A, an
orientation to Alameda County Health Care Services, and overviews of the Brown Act, Conflict of
Interest Code and Political Reform Act.
Following the introductory meetings, the Committee decided the most efficient method to review
Measure A expenditures was to hear presentations from each major entity that received funding
in FY 04/05, beginning from the most straightforward to the most complex:
Month Presenting Agency
March School-Based Health Center Coalition
April Primary Care Clinics
May Private and District Hospitals and Physician Reimbursement Accounts
June Alameda County Public Health and Behavioral Health Care Services
July Alameda County Medical Center
Each agency was given a standard set of questions to address in their presentations:
1. What is your agency’s overall budget?
2. What portion of your overall budget is Measure A funding?
3. Please list your program and/or agency objectives.
4. Please provide information on how Measure A funds were allocated.
5. Describe how Measure A funds were used to help meet the program objectives?
6. Please list your key accomplishments in FY 04/05.
7. Discuss challenges in obtaining your objectives. Did any objectives change? If so, what
are they and why did they change?
8. How is the impact of Measure A funds measured in achieving your objectives, including
expansion and/or maintenance of services?
9. What are your objectives for FY 05/06?
Contact Jennifer Chan, Measure A Financial Manager at (510) 618-2016 or
jennifer.chan@acgov.org for copies of presentations.
The Oversight Committee continues to meet monthly. The meetings are public and generally
scheduled on the fourth Friday of every month from 9-11:30am at the Alameda County Health
Care Services Agency Administration office building (subject to change). Meeting agendas and
minutes are posted on the Alameda County website at:
http://www.acgov.org/health/meetings.htm
SECTION 7 – FOR MORE INFORMATION
For more information regarding Measure A, please visit the Alameda County Health Care Services
Agency website at: http://www.acgov.org/health/meetings.htm
You may also contact Jennifer Chan, Measure A Financial Manager, at (510) 618-2016 or
jennifer.chan@acgov.org.
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APPENDIX
Appendix A: Measure A Revenue Received in FY 04/05
Appendix B: FY 04/05 Measure A Fund Distribution by Provider or Program
Appendix C: Detoxification / Sober Station Update
Appendix D: Maps – Geographic Distribution of Providers Receiving
Measure A Funds in FY 04/05
25 of 40
APPENDIX A:
MEASURE A REVENUE RECEIVED IN FY 04/05
MEASURE A REVENUES RECEIVED TO DATE
FISCAL YEAR 04/05
Date Rec'd Month Earned ACMC COUNTY TOTAL
9/22/04 07/04 5,211,585 1,737,195 6,948,780
10/21/04 08/04 5,142,150 1,714,050 6,856,200
11/19/04 09/04 6,856,200 2,285,400 9,141,600
12/28/04 10/04 5,494,355 1,831,452 7,325,807
01/19/05 11/04 5,437,350 1,812,450 7,249,800
02/17/05 12/04 7,249,800 2,416,600 9,666,400
03/31/05 01/05 6,299,953 2,099,984 8,399,937
04/21/05 02/05 4,291,500 1,430,500 5,722,000
05/18/05 03/05 5,722,050 1,907,350 7,629,400
06/24/05 04/05 8,412,419 2,804,139 11,216,559
07/20/05 05/05 4,988,025 1,662,676 6,650,700
08/19/05 06/05 6,650,700 2,216,900 8,867,600
Interest earned 116,927 116,927
TOTAL 71,756,087 24,035,623 95,791,710
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APPENDIX B:
FY 04/05 MEASURE A FUND DISTRIBUTION BY PROVIDER OR PROGRAM
FY 04/05
Measure A
Allocation
Expended /
Encumbered
Public Health Prevention Initiative
Chronic Disease and Injury Prevention
Community Designed Initiative $125,000 $0
Injury Prevention and Project New Start $116,917 $2,969
Asthma Start $211,542 $11,738
Diabetes Peer Educators $261,404 $63,671
Healthy Kids, Healthy Teeth $147,836 $57,330
Health Inequities and Capacity Building
Community Designed Initiative $50,000 $0
Community Capacity Building $640,568 $158,171
IZ Registry $197,264 $0
HIV Prevention $82,800 $0
Community Nursing $98,508 $10,556
Healthy Passages $98,465 $0
Obesity Prevention & School Health
Community Designed Initiative $170,000 $0
Obesity Prevention Healthy Living Council $397,306 $22,980
School Nursing Partnership $177,390 $30,621
City of Berkeley $225,000 $0
TOTAL $3,000,000 $358,036
ER and On-Call Physician Reimbursement
*Funds expended based on claims submitted by providers; specific allocations
were not made for each provider.
$1,500,000
Aguedo A Retodo Jr MD n/a $6,483
Alameda Anesthesia Associates Med Group n/a $16,931
Bay Imaging Consultants Medical Group LLC n/a $17
Bay Surgeons Medical Group n/a $1,118
Berkeley Emergency Med Group Inc n/a $308,768
California Emergency Physicians n/a $307,302
Chabot Nephrology Medical Group Inc n/a $3,037
Clarence A Boyd Jr. MD n/a $8,271
Darrell Hayes MD n/a $8,167
David K Berke MD n/a $156
Desmond Eramus MD n/a $905
Dewitt Gifford MD n/a $5,641
Drew and Raskin MD Partnership n/a $1,056
Dwight Winniger MD n/a $2,852
East Bay Pulmonary Medical Group n/a $354
Eden Emergency Medical Group Inc n/a $8,833
Elena Patterson MD n/a $1,750
Emergency Med Assoc of Children's n/a $84,349
First Surgical Consultants Medical Group n/a $13,486
Fremont Anesthesia Consultants Med Group n/a $6,066
Fremont Ear, Nose and Throat Medical Group Inc n/a $923
Garfield D Bryant n/a $1,164
Gastroenterology Specialist Med Group n/a $1,579
Gearhart / Araj Surgeons Med Group Inc n/a $2,551
General Vascular Surgery Medical Group n/a $12,047
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FY 04/05
Measure A
Allocation
Expended /
Encumbered
Jack H Stehr MD n/a $858
James G Bryant n/a $352
Jay Garfinkle MD - A Professional Corp n/a $2,230
Jay James Strain MD n/a $3,804
Jeffrey B Randall MD n/a $9,335
John P Heine MD n/a $116
Kristen Lynn Engle MD n/a $11,800
Louise Hom n/a $115
Michael B Krinsky n/a $405
Myo Thant Maung MD n/a $1,400
Northern CA Trauma Medical Group Inc n/a $21,090
Nuzrat Zaidi MD n/a $1,683
Oakcare Medical Group Inc n/a $279,786
Pediatric Surgical Assoc of the E Bay n/a $4,685
Phoenix Emergency Physicians n/a $79,723
Pleasanton Emergency Medical Group n/a $34,636
R Scott Snyder MD Inc n/a $11,176
R.S. Rajah MD Inc n/a $63
Reveendra Nadaraja MD Inc n/a $79,653
Ricardo E Aguirre MD Inc n/a $45
Sammy T Hung MD Inc n/a $573
Steven Oppenheimer MD n/a $86
Valley Memorial Emergency Medical Group n/a $29
Valleycare Gastroenterology Medical Group Inc n/a $82
Vasiliki Economou n/a $526
William Mills Jr MD n/a $464
Zealous D Wiley, E Michael Darby n/a $1,041
Zulfiqar Ali n/a $436
TOTAL $1,500,000 $1,350,000
Behavioral Health CBO Providers
Alameda County Network of Mental Health Clients $24,557 $24,557
Ann Martin Children's Center, Inc. $9,432 $9,432
Asian Community Mental Health Services $53,279 $53,279
Asian Community Mental Health Services $3,359 $3,359
Asian Pacific Psychological Services $4,216 $4,216
Axis Community Health, Inc. $20,638 $20,638
BACS-Case Management $22,973 $22,973
BACS-CLC $32,830 $32,830
BACS-Woodroe Place $23,807 $23,807
Berkeley Addiction Treatment Services, Inc. (B.A.T.S.) $4,894 $4,894
Berkeley Place-Casa DeLa Vida $24,646 $24,646
Bi-Bett Corporation $32,251 $32,251
Bonita House - Residential $31,074 $31,074
Bonita House-CLC Full Day Rehab $2,431 $2,431
Bonita House-McKinney $943 $943
Bonita House-non CLC $1,792 $1,792
Bonita House-Service Team $17,394 $17,394
Building Opportunities for Self Sufficiency (B.O.S.S.) $1,829 $1,829
Building Opportunity for Self Sufficiency $55,223 $55,223
Carnales Unidos Reformando Adictos, Inc.-Fremont (C.U.R.A.) $9,077 $9,077
Carnales Unidos Reformando Adictos, Inc.-Oakland (C.U.R.A.) $9,076 $9,076
Center for Independent Living $1,907 $1,907
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FY 04/05
Measure A Allocation
Expended /
Encumbered
Change Thru Xanthos, Inc.-Tri-High $6,806 $6,806
Change Thru Xanthos-CEC $2,186 $2,186
Coalition for Alternatives in Mental Health $1,255 $1,255
Community Counseling and Education Center (C.C.E.C.) - Adolescent $5,032 $5,032
Community Counseling and Education Center (C.C.E.C.) - FNL $11,191 $11,191
Community Counseling and Education Center (C.C.E.C.) - Youth $5,032 $5,032
Crisis Support Services $25,740 $25,740
Davis Street Community Center $8,941 $8,941
East Bay Agency for Children-Therapeutic Nursery School $52,017 $52,017
East Bay Asian Youth Center $2,490 $2,490
East Bay Community Recovery Project $9,006 $9,006
East Bay Community Recovery Project-Criminal Justice $6,136 $6,136
East Bay Community Recovery Project-Perinatal $25,351 $25,351
Filipinos for Affirmative Action $1,867 $1,867
Fred Finch Youth Center-School-based Day Treatment $17,110 $17,110
Health and Human Resource Education Center $962 $962
Health and Human Resource Education Center $4,166 $4,166
Horizon Services-Chrysalis $34,122 $34,122
Horizon Services-Cronin House $36,877 $36,877
Horizon Services-Project Eden $20,105 $20,105
Humanistic Alternatives To Addiction, Research, and Treatment, Inc.-Hayward $2,565 $2,565
La Cheim - Alvarado Half Day $14,973 $14,973
La Cheim - Mental Health Services $8,949 $8,949
La Cheim - Oak Part Half Day $11,021 $11,021
La Clinica - Adult Services $30,168 $30,168
La Clinica - Children Services $10,655 $10,655
La Familia - Intensive Day Treatment $20,768 $20,768
La Familia - Outpatient $31,150 $31,150
Latino Commission-Adolescent Treatment $40,000 $40,000
Latino Commission-Centro de Juventud/Primavera $5,000 $5,000
Latino Commission-Si Se Pureed $4,999 $4,999
Lifelong Medical Care $3,252 $3,252
Lincoln Child Center $31,463 $31,463
Magnolia Recovery Program, Inc. $4,188 $4,188
Mental Health Association - Advocacy $12,888 $12,888
Mental Health Association - Advocacy $5,597 $5,597
Mental Health Association - Advocacy and Support $4,813 $4,813
Mental Health Association - Hearings $11,224 $11,224
Mental Health Association - Representation $7,143 $7,143
Native American Health Center $2,511 $2,511
New Bridge Foundation Inc. $37,410 $37,410
Oakland Independent Support Center $5,593 $5,593
Parental Stress-Mental Health Services $7,532 $7,532
Parental Stress-Promotion $9,757 $9,757
Regents of the UC - Center on Deafness - Adults $3,211 $3,211
Regents of the UC - Center on Deafness - Children $3,250 $3,250
RL Geddins Women's Empowerment Network $4,765 $4,765
Second Chance - Perinatal $13,538 $13,538
Second Chance Ashland Center $23,477 $23,477
Second Chance-Hayward ODF $21,465 $21,465
Seneca Center-San Leandro Day Treatment $134,772 $134,772
St. Mary's Recovery Center $3,237 $3,237
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FY 04/05
Measure A
Allocation
Expended /
Encumbered
STARS - Day Treatment $24,959 $24,959
Supplement Rate Program $44,805 $44,805
Telecare-CHANGES Service Teams $26,661 $26,661
Telecare-Garfield $110,989 $110,989
Telecare-Gladman-Rehab $76,587 $76,587
Telecare-Mort Bakar $213,557 $213,557
Telecare-STAGES $12,170 $12,170
Telecare-STRIDES Service Teams $35,436 $35,436
Telecare-Susal Creek $70,686 $70,686
Telecare-Training $6,363 $6,363
Telecare-Villa Fairmont $232,708 $232,708
The Solid Foundation - Mandela I $9,416 $9,416
The Solid Foundation-Keller House $12,679 $12,679
The Solid Foundation-Mandela II $14,512 $14,512
The Solid Foundation-MFC $5,108 $5,108
The Solid Foundation-Women's Center $4,905 $4,905
Thunder Road - Adolescent $10,222 $10,222
Tri-Valley Community Foundation-Senior Support Program $1,792 $1,792
Urban Indian Health Board $3,200 $3,200
West Oakland Health Center - Children $59,877 $59,877
West Oakland Health Center - Trouble House $6,900 $6,900
West Oakland Health Council, Inc.-Perinatal $50,735 $50,735
Xanthos - ODF Adolescent $5,782 $5,782
Xanthos - ODF Adult $5,719 $5,719
Y.M.C.A. $7,846 $7,846
ZDK, Inc.-The 14th St. Clinic $1,032 $1,032
TOTAL $2,250,000 $2,250,000
Detoxification / Sober Station $2,000,000 $0
Primary Care CBOs
Asian Health Services $726,093 $726,093
Bay Area Consortium for Quality Health Care $246,013 $246,013
AXIS Community Health Center $420,626 $420,626
La Clinica de la Raza $1,051,147 $1,051,147
Life Long Medical Care $712,341 $712,341
Native American Health Center $321,859 $321,859
Tri-Cities Health Center $515,642 $515,642
Tiburcio Vasquez Health Center $525,643 $525,643
West Oakland Health Center $480,636 $480,636
TOTAL $5,000,000 $5,000,000
Private and District Hospitals
Children's Hospital Oakland $2,250,000 $2,250,000
St. Rose Hospital $2,250,000 $2,250,000
TOTAL $4,500,000 $4,500,000
School-Based Health Clinics (SBHCs)
Maintaining Existing Services
Base Funding for Existing SBHCs $220,000 $194,028
One-Time Only Capacity Building Grants $145,100 $139,187
Service Expansion
Planning and Base Funding for 2 new SBHCs $40,000 $0
Coordinated School Sites $90,000 $0
Data Needs Assessment and Planning Technical Assistance $28,000 $10,438
One-Time Only Service Expansion Grants $138,156 $133,492
Capital Reserve $210,000 $0
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FY 04/05
Measure A
Allocation
Expended / Encumbered
Service System Coordination
Fund Development $13,750 $0
Program Coordination $28,000 $28,000
Administrative Infrastructure and Support $21,667 $0
One-Time Only Strategic Planning Grants $38,155 $14,044
Professional Development and Training $27,172 $22,419
TOTAL $1,000,000 $541,608
Other
Health Insurance Expansion $250,000 $0
Board of Supervisors Discretionary Allocation $500,000 $0
TOTAL $750,000 $0
GRAND TOTAL $20,000,000 $14,000,000
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APPENDIX C:
DETOXIFICATION / SOBER STATION UPDATE
This 32-bed adult facility, with an average projected stay of three to five days, will be located at a
soon-to-be remodeled building on the Fairmont Hospital Campus. The detox program will offer a
new and necessary service for the low-income and indigent residents of Alameda County who
suffer from the debilitating effects of alcohol and substance abuse and frequently co-occurring
mental illnesses.
The companion program, a Sobering Center, where as many as 50 adults will spend an average of
four to six hours in a medically monitored environment in which inebriates can allow the effects of
chemical intoxicants to abate and to regain their functionality, will open in November 2007. The
Sobering Center will be located on the Fairmont Hospital Campus across the street from the
Detox facility in a new 7200 square foot building. The development of both of these programs is
the result of a now 2+ year collaborative effort between the County, cities, and CBOs. Both
programs will be contracted out by Behavioral Health Care Services to CBOs after a Request for
Proposal process to begin in February 2007.
Several transport vans, staffed with an emergency medical team and outreach worker, will pick
up individuals and take them to the Sobering Center. The intent of the transport vans will be to
provide intervention, medical evaluation, and transportation in a safe and compassionate manner
which preserves the dignity of clients. Additionally, these new services will include vans to
transport individuals from the Sobering Center to other existing services. These services will
include shelters, treatment programs, and returns to the community from which the individual
came. The design of the transport van program is well underway with a ramp-up approach to
accommodate the logistics of our large county and its 14 cities. This essential component of the
Detox-Sobering Project will be coordinated to begin services with the opening of the Sobering
Center in November 2007.
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APPENDIX D:
MAPS – GEOGRAPHIC DISTRIBUTION OF
PROVIDERS RECEIVING MEASURE A FUNDS IN FY 04/05
Page 34: School-Based Health Centers
Page 35: Primary Care Community-Based Organization Clinics
Page 36: County, Private and/or Non-Profit Hospitals and Alameda County
Public Health Department Programs
Page 37: Emergency Rooms where ER and/or On-Call Physicians Provided
Service
Page 38: Alameda County Behavioral Health Department –
Alcohol and Drug Treatment Service Providers
Page 39: Alameda County Behavioral Health Department –
Adult and Children Mental Health Service Providers
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