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MEASURE A
Essential Health Care Services
Tax Ordinance
OVERSIGHT COMMITTEE
4TH REPORT
TO THE ALAMEDA COUNTY
BOARD OF SUPERVISORS
AND THE PUBLIC
REVIEW OF EXPENDITURES IN
Fiscal Year (FY) 2008/2009
July 1, 2008 – June 30, 2009
&
Fiscal Year (FY) 2009/2010
July 1, 2009 – June 30, 2010
MEASURE A
Essential Health Care Services Tax Ordinance
OVERSIGHT COMMITTEE
4TH REPORT
TO THE ALAMEDA COUNTY BOARD OF SUPERVISORS
AND THE PUBLIC
REVIEW OF EXPENDITURES IN
Fiscal Year (FY) 2008/2009
July 1, 2008 – June 30, 2009
&
Fiscal Year (FY) 2009/2010
July 1, 2009 – June 30, 2010
3/11
Table Of COnTenTs
Measure a Oversight COMMittee MeMbers .................................................................................................. 1
exeCutive suMMary ...................................................................................................................................... 3
seCtiOn 1: Funding allOCatiOn and review PrOCess ................................................................................... 7
seCtiOn 2: hOw the MOney was sPent ....................................................................................................... 9
review OF Fy 08/09 and Fy 09/10 exPenditures: 75% OF Measure a Funds
allOCated tO the alaMeda COunty MediCal Center ..................................................................................... 11
review OF Fy 08/09 and Fy 09/10 exPenditures: 25% OF Measure a Funds
allOCated by the alaMeda COunty bOard OF suPervisOrs ............................................................................. 14
grOuP 1: behaviOral health 1
Alameda County Behavioral Health Care Services Community-Based Organization Providers ............ 15
Alameda County Behavioral Health Care Services Detoxification/Sobering Station ............................ 16
Mental Health Costs for Juvenile Justice Center .................................................................................. 19
Mental Health Costs for Glen Dyer Jail in Oakland ............................................................................. 20
Criminal Justice Screening/In-Custody Services at Santa Rita Jail ....................................................... 21
grOuP 2: hOsPital, tertiary Care, Other
Administration/Infrastructure Support .............................................................................................. 23
Children’s Hospital ............................................................................................................................. 24
St. Rose Hospital ................................................................................................................................. 26
Measure A Funds Used to Partially Offset Base Funding Erosion
in Health and Mental Health Realignment Revenues .......................................................................... 27
grOuP 3: PubliC health
Alameda County Public Health Department: Prevention Initiative ...................................................... 28
Emergency Room and On-Call Physician Reimbursement ................................................................. 30
Bay Area Community Services ............................................................................................................ 31
Center for Community Benefit (CBO Center) ..................................................................................... 32
grOuP 4: PriMary Care
Primary Care Community-Based Organizations ................................................................................. 33
School Health Services Coalition (Formerly School-Based Health Centers) ........................................ 35
Medical Costs for Juvenile Justice Center ............................................................................................ 38
Healthy Communities, Inc. ................................................................................................................. 39
Preventive Care Pathways .................................................................................................................... 40
Other Capital (Alameda Hospital) ..................................................................................................... 41
2007 Capital Investment in the County’s Health Care Safety Net ........................................................ 42
grOuP 5: bOard OF suPervisOrs disCretiOnary allOCatiOns ......................................................................... 43
aPPendiCes ................................................................................................................................................. 49
aPPendix a: Measure a revenue reCeived in eaCh FisCal year ........................................................................ 51
aPPendix b: Fy 08/09 and Fy 09/10 budget inFOrMatiOn ........................................................................ 55
aPPendix C: Fy 08/09 and Fy 09/10 Measure a Fund distributiOn by PrOvider Or PrOgraM ....................... 57
aPPendix d: MaPs: geOgraPhiC distributiOn OF PrOviders reCeiving Measure a Funds
in Fy 08/09 and Fy 09/10 .................................................................................................................... 62
alaMeda COunty hOsPitals (COunty and Private) and PubliC health PrOgraMs ................................... MaP 1
PhysiCian reiMburseMent-eMergenCy rOOM lOCatiOns ......................................................................... MaP 2
alaMeda COunty behaviOral health Care serviCes alCOhOl and drug PrOviders ................................... MaP 3
alaMeda COunty behaviOral health Care serviCes Mental health
COMMunity-based OrganizatiOn PrOviders ......................................................................................... MaP 4
adOlesCent sChOOl-based health Centers .......................................................................................... MaP 5
PriMary Care COMMunity-based OrganizatiOns .................................................................................. MaP 6
1
Measure a OversighT COMMiTTee MeMbers
COMMITTEE MEMBER REPRESENTING/NOMINATED BY
Barbara Spaulding Anglin Central Labor Council
Ken Ballard, Pharm D. League of Women Voters (resigned in November 2010)
Suzanne Barba League of Women Voters
John Becker City Manager’s Association
LeRoy Blea City of Berkeley
Arthur Chen Alameda Contra Costa Medical Association
Louis Chicoine Supervisorial District 1
Gloria Crowell Alameda County Public Health Commission (resigned in December 2010)
Kay Eisenhower Supervisorial District 4
Arthur Geen Alameda County Taxpayers Association
Deborah Pitts-Cameron Hospital Council of Northern California
Beth Pollard City Manager’s Association
Stephen Post Alameda County Mental Health Board (resigned in July 2010)
Don Sheppard Supervisorial District 2 (term ended in December 2010)
Mee Ling Tung Supervisorial District 3
2
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One OF the PrOvisiOns of Measure A required the establishment of a Citizen Oversight Committee. The
role of the Committee is to annually review Measure A expenditures for each fiscal year and report
to the Board on the conformity of such expenditures to the purposes set forth in the Measure.
The Measure states: “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.”
This report is based on a number of sources:
• self-reported information provided by recipients of Measure A funds
• a presentation by the Alameda County Medical Center (Medical Center)
• the County Health Care Services Agency, which monitors the contracts with recipients of Measure
A funds—including negotiating scope of work and payment schedule, developing actual contracts,
preparing letters to the Alameda County Board of Supervisors (Board) for approval, authorizing
payments, and tracking expenditures.
Measure A, the Essential Health Care Services Initiative, was passed by 71% of Alameda County voters
in March 2004. It authorized the County of Alameda to raise its sales tax by one-half cent in order to
provide 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. These services faced sharply increasing costs
with inadequate resources to meet the needs of County residents. Measure A funds substantially eased the
countywide crisis in health care; however, the economic downturn experienced during the period covered
in this report has threatened some of the gains achieved.
The initiative generated $101,261,219 in FY 08/09 and $94,117,187 in FY 09/10. The Medical Center
received 75% of these funds, and the Board distributed the remainder of the funds to other health care
providers, including:
• initiatives funded by the Alameda County Public Health Department and Behavioral Health Care Services
• emergency room physicians
• primary care clinics
• Children’s and St. Rose Hospitals
• school-based health centers.
In addition to helping the Medical Center stabilize its budget and expand its health care services, Measure A has
helped enable serious long-term planning to meet future health care needs for County residents. For example,
the Public Health Department has used Measure A funds to examine and address health inequities within
the client population and to develop a strategic plan. These initiatives will continue to bear fruit over time.
exeCuTive suMMary
4
MAJOR CONCLUSION
The Oversight Committee found that the Medical Center and the other recipients of sales tax revenue spent
the funds in compliance with the strictures of Measure A. In addition, the Committee found that in both
FY 08/09 and FY 09/10 Measure A enabled expansions in services and facilities, which reflects the stated
primary goal of the Measure.
HIGHLIGHTS
Measure A revenues are critical to maintain access to medical services by indigent, uninsured, and low-
income residents of Alameda County, who depend on the County’s health care safety net. According to state
data, 11.5% of County residents, about 171,000 people, are uninsured. To help address this large need,
recent and ongoing federal health care reform could potentially provide the County with more options for
providing services to the Measure A population.
During the years under review, the sales tax revenue received through Measure A enabled the following
positive developments in the delivery of health care services:
• Despite the down economy and decrease in sales tax revenue, Measure A enabled a large number of
providers to continue existing programs and maintain the service levels offered by these programs.
• Measure A funds increased access to health care services for organizations ranging from the Medical
Center to school-based health centers. Wait times for services, whether in clinics, jails/Juvenile Justice
Center, or outreach-based programs, decreased among most fund recipients.
• Several recipients, such as St. Rose Hospital, school-based health centers, and the Juvenile Justice Center
Victims of Crime unit, used Measure A funds as leverage to draw down matching funds, both federal and
foundation grants.
• Many organizations and departments, including the Public Health Department and the school-based
health centers, used Measure A funds to increase health outreach and education efforts, with a focus on
prevention. Measure A also allowed for the continuation and expansion of mental health services among
many providers.
• The two-year review period saw the continued growth of collaboration among the County, the Medical
Center, the Public Health Department, and community-based clinics. Measure A helped fund some of
these collaborative efforts.
• Measure A gives the County flexibility to address unmet needs and unanticipated costs. Specifically, the $1
million Board allocation gives the Supervisors the flexibility to respond to unanticipated needs in their
districts.
• Each member of the Board of Supervisors recommended allocations for approval by the Board as a whole.
In both FY 08/09 and 09/10, the budgeted allocation per district was $209,090. Over the period of this
report, there were 42 contracts for services for youth, children, seniors, and the general population from
the allocations. During this period, the Committee noted an increased focus on healthy living, wellness,
and prevention initiatives.
• The Committee noticed a general improvement in the quality and level of detail in recipient reporting
compared to prior years.
CONCERNS
In developing this report, the Oversight Committee has identified several concerns regarding the state of
health care funding during the years of Measure A implementation (2004-2010), including a decrease
in the rate of growth in sales tax revenue, health care funding cuts, and an increase in the number of
uninsured Alameda County residents. For the first time since the implementation of Measure A, sales tax
receipts actually decreased year-to-year over the two years covered in this report. This translates to a decrease
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in Measure A funding. Even with this decline, for the 25% of Measure A funding allocated by the Board of
Supervisors, the Board maintained its funding allocation to its providers for both FY 08/09 and 09/10.
However, the FY 10/11 budget/allocations generally include an across-the-board reduction of 25%. The
Committee is concerned that continuing cuts in state and federal support for health care, combined with a
decrease in Measure A sales tax revenue, will result in an increase in the health disparities across different
communities that the Measure addresses.
At the same time, unemployment has been on the rise from FY 08/09 into FY 09/10, potentially increasing
the number of indigent, uninsured, and low-income Alameda County residents who might seek Measure
A-funded services.
Recent federal regulations and funding cuts will add to the County’s health care burden. Measure A revenues
help fill this gap, but as federal and state cuts continue, it will be harder for County medical services to meet
the increased needs of low-income, uninsured, and indigent patients.
Outside of the area of health care funding, the Committee has an ongoing concern that the composition of
the Committee does not reflect the diverse make-up of the population served by Measure A.
The Committee raised concerns regarding Measure A funding specifically, including the following:
Reporting and Review Concerns
• The County Counsel has stated that Committee’s charge does not include reviewing the efficiency of
programs funded by Measure A. The Committee expresses concern that this interpretation of the Measure
A ordinance limits the Committee’s ability to review program efficacy and cost-effectiveness.
• The Committee has not reviewed the Health Care Service Agency’s process of controls and review of how
the money is spent— via audit or other method. The Committee has therefore not reviewed any of the
documentation the Health Care Services Agency has received to monitor their control of how the Measure
A money has been spent. In response to this, the Committee is trying to address its process to do a better
job soliciting the information it needs.
• The Committee’s review was impacted by the varying level of detail provided in the reports, as well as
varying levels of responsiveness to specific questions posed by the Committee to specific recipients. This
makes it difficult for the Committee to determine whether money is being spent on the Measure A target
population. As one example, many fund recipients provide services to seniors—however, the Committee
is aware that many seniors do not qualify as low-income, uninsured, or indigent.
Medical Center
A significant portion (approximately 1/3) of Measure A revenues is used by the Medical Center to pay off
debt and interest, primarily to the County. Much of this debt was incurred before Measure A was passed
in 2004, and there was no mention in the ballot arguments or in the campaign itself that Measure A funds
would be used in this way. For years the Medical Center has been involved in disputes about this debt and
whether it was legitimately incurred—for example, critics argue that the County was not paying its fair
share towards medical care for the indigent and uninsured.
Detoxification Center/Sobering Station
• As an overall concern, the stated program objectives are not measurable, making it difficult to evaluate the
program for any progress.
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• Because reporting for FY 08/09 and FY 09/10 used different metrics, it is hard for the Committee to
determine if the programs have shown either maintenance of or improvement in services over the two-
year reporting period.
• In FY 08/09, the Sobering Center as a standalone entity was found not to be cost-effective. A new
blended approach to detoxification services was planned and implemented in FY 09/10. However, in
FY 09/10, no progress report was provided on the Safe House-Sobering Center, and no figures were
provided on actual costs encumbered.
Mental Health Costs for Juvenile Justice Center
As an overall concern, the stated program objectives are not measurable, making it difficult to evaluate the
program for any progress.
Mental Health Costs for Glen Dyer Jail in Oakland
As an overall concern, the stated program objectives are not measurable, making it difficult to evaluate the
program for any progress.
Bay Area Community Services
The funding received from Measure A was a one-time allocation to help Bay Area Community Services
address a financial crisis and preserve services to a vulnerable population. Bay Area Community Services
was not able to verify whether or not recipients of the Measure A-funded services were uninsured or
underinsured. While the Oversight Committee understands that the recipients of these services were likely
to be eligible, the Committee would prefer to have eligibility verified. The Committee is also concerned that
this Measure A allocation may be a case of Measure A funding an activity in order to address a community-
based organization’s financial crisis. The intent of Measure A funding is to ensure the continuance or support
the expansion of a specific program or activity itself.
Board of Supervisors Discretionary Allocations
• Some allocations are for direct services, while others are informational, preventive, or long-term focused
and therefore more difficult to quantify. It would be helpful to the Committee’s reporting ability if the
Board of Supervisors would work with the Health Care Services Agency to establish a matrix on how the
allocations meet the purpose of Measure A.
• There is no process for soliciting or screening individual Board allocations, which allows for creativity
in exploring new approaches to delivering health care, but calls into question how providers that target
those needs know to apply for the discretionary Measure A funds.
• The number of recipient contracts rose 30% between FY 08/09 and FY 09/10, from 18 to 24 contracts,
which requires the use of additional Health Care Services Agency administrative time. When the
allocation is a small amount and a small percentage of the program budget, it is less meaningful than
when it is substantial enough in dollars or in percentage of the program budget to make a difference in
whether services can be provided.
FOR MORE INFORMATION
The full report of the Oversight Committee and all supporting documents are available online at www.
acgov.org/health/. For more information about Measure A expenditures or the Committee, please contact
Jennifer Chan at (510) 618-2016 or Jennifer.Chan@acgov.org.
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seCTiOn 1
FUNDING ALLOCATION AND REVIEW PROCESS
The language of Measure A allocates funds as follows:
• The Alameda County Medical Center (Medical Center) receives a direct allocation of 75% of funds.
• The Alameda County Board of Supervisors (Board) allocates the remaining 25%.
On December 14, 2004, after initial passage of the Measure, the Board approved three-year funding
allocations of its 25% share of Measure A funds in eight general categories:
• The Alameda County Public Health Department Prevention Initiative
• Emergency Room and On-Call Physician Compensation
• Alameda County Behavioral Health Care Services (Behavioral Health Care) Community-Based
Organization Providers
• Alameda County Detoxification/Sober Station
• Community-Based Organization Primary Care Clinics
• Private Hospitals/Non-Public with Disproportionate Share Hospital (DSH) Designation (hospitals that
serve a disproportionate number of Medi-Cal, uninsured, and indigent patients)
• School-Based Health Centers
• Health Insurance Expansion and Board of Supervisors Discretionary Allocation.
When these three-year funding allocations expired in June 2007, the Board agreed that maintaining most of
the existing allocations would best sustain a level of care to the County’s residents. The funding allocations
in the eight categories generally remained the same and the Board approved another three-year allocation
through June 2010.
As a tool for reviewing funding allocations, the Measure A Oversight Committee developed a reporting
form, containing questions on specific uses of funds received, for all Measure A fund recipients to complete.
The Committee revised the forms during this two-year period to solicit more specific information from
fund recipients. While further refinements may be needed, the revision seems to have improved the quality
of reports returned. The Committee also heard a presentation from the Medical Center. The Committee used
the report forms returned by most Measure A fund recipients, along with the Medical Center presentation,
to review all funding allocations. As in prior years, varying levels of detail provided in the reports, as well as
varying levels of responsiveness to specific questions posed by the Committee to specific recipients, made
it difficult for the Committee to evaluate the reports consistently and thoroughly. However, as noted, the
revised form seems to have resulted in improved reporting from the providers.
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seCTiOn
HOW THE MONEY WAS SPENT
The Alameda County Medical Center (Medical Center) receives 75% of Measure A funds through a specific
designation. The Medical Center Board of Trustees allocates these funds within the Medical Center. The
Alameda County Board of Supervisors (Board) allocates the remaining 25% of Measure A funds. The
Alameda County Health Care Services Agency manages these funds.
Figure 1
DISTRIBUTION OF MEASURE A FUNDS
FY 08/09
In FY 08/09, Measure A generated $101,261,219 (not including interest earned). The funds were
distributed as follows:
Alameda County Medical Center (ACMC) (75%) $75,951,290
Alameda County (non-ACMC) (25%) $25,309,929
TOTAL $101,261,219
In FY 08/09, the Alameda County budget totaled $2,395,200,000. The Health Care Services Agency budget
totaled $551,824,000, or 23.04% of the total County budget. Measure A funds not specifically designated
for the Medical Center accounted for 5.32% of the Health Care Services Agency budget.
FY 09/10
In FY 09/10, Measure A generated $94,117,187 (not including interest earned). The funds were distributed
as follows:
2
25%
75%
Alameda County Board of Supervisors
Alameda County Medical Center Board of Trustees
10
Alameda County Medical Center (ACMC) (75%) $70,587,890
Alameda County (non-ACMC) (25%) $23,529,297
TOTAL $94,117,187
In FY 09/10, the Alameda County budget totaled $2,429,900,000. The Health Care Services Agency budget
totaled $591,562,000, or 24.35% of the total County budget. Measure A funds not specifically designated
for the Medical Center accounted for 4.96% of the Health Care Services Agency budget.
The following sections provide more detail on the allocation and expenditure of Measure A funds.
11
REVIEW OF FY 08/09 AND FY 09/10 EXPENDITURES:
75% OF MEASURE A FUNDS ALLOCATED TO
THE ALAMEDA COUNTY MEDICAL CENTER
FY 08/09 allocation: $75,951,290
Expended/encumbered: $75,951,290
FY 09/10 allocation: $70,587,890
Expended/encumbered: $70,587,890
Figure 2
AlAMEDA COUNTy MEDICAl CENTER TOTAl ANNUAl REvENUE
AGENCY/PROGRAM BACKGROUND
The Alameda County Medical Center provides the
majority of indigent, uncompensated, and charity
care in Alameda County. Measure A revenue helps
fill the funding gap left after Medi-Cal, Medicare,
and other payer sources fail to satisfy the full cost of
services provided to County residents. The Medical
Center receives 75% of all Measure A revenue to
support its network of three hospitals – Highland,
Fairmont, and John George Psychiatric Pavilion – and
its three satellite clinics: Eastmont Wellness, Winton
Wellness, and Newark Health Center.
MEASURE A FUNDING SUMMARY
For the first time since the Medical Center began receiving Measure A funds, the total generated by the
sales tax decreased rather than increased in successive budget years. In FY 08/09, Measure A funds supplied
15.8% of the Medical Center’s overall budget. In FY 09/10, this dropped to 14% of the overall budget.
Fortunately, the Medical Center took in increased revenues elsewhere in the budget that helped offset the
decrease in Measure A funds.
MEDICAL CENTER HIGHLIGHTS
FOR FY 08/09 AND FY 09/10
• reduced clinic waiting times
• savings of over $3 million in FY 09/10
• expanded service offerings
through the Newark Health Center
renovation and the newly established
Fall Prevention Center
• improved ranking among both
hospitals serving the uninsured and
all Bay Area hospitals
Measure ARevenue
16%
Non-Measure A Revenue
Measure A
Revenue
14%
Non-Measure A Revenue
Supplementals 24%Supplementals 25%
Patient Services
38%
Patient Services
41%
All Other 22%All Other 20%
Fy 08/09 Fy 09/10
12
Unlike most community clinic and private
hospital recipients, the Medical Center does not
use Measure A money to fund specific programs.
Instead, Measure A funding is critical to the
Medical Center’s ability to serve as the safety net
medical center for the County. Measure A funds
provide the Medical Center with more flexibility
in absorbing annual health care cost increases
when other payer sources, such as Medi-Cal and
Medicare, don’t pay the full cost of service.
Figure 3
MEASURE A REvENUE TREND
Budget figures show the decrease in Measure A
funding to the Medical Center between FY 07/08 and
FY 09/10
$100 M
$90 M
$80 M
$70 M
$60 M
$50 M
$40 M
$30 M
$20 M
$10 M
$0 FY 07/08
$86,889,558
FY 08/09
$75,951,290
FY 09/10
$70,587,890
HIGHLIGHTS
During the two-year period covered in this report, the Medical Center reduced the wait times in its clinics.
While the Medical Center experienced a drop in inpatient volume, the number of emergency room visits
increased. The Skilled Nursing Facility at Fairmont is generally full, and John George is usually at full
capacity. Outpatient visits in FY 09/10 increased by 1% over FY 08/09, while surgeries increased 3% in the
second year. In FY 09/10, the Medical Center saved $3.3 million from its expense budget.
With respect to its relationship with the community, the Medical Center increased public participation at
John George; produced two editions of its community newsletter and mailed it to 20,000 households;
moved up from #2 to #1 in the Bay Area for hospitals treating the uninsured; and moved up from #11 to
#7 for all Bay Area hospitals. The Medical Center initiated a renovation project at Newark Health Center that
will considerably expand services in southern Alameda County when it is completed in early 2011. It also
started the Fall Prevention Center at the Highland campus in March 2010, a unique one-stop service for
older adults identified in the Emergency Department or clinics as being at high risk for falls.
The Committee notes that reports returned by the Medical Center for FY 08/09 and FY 09/10 were greatly
improved over earlier reports. Adding a human touch to its report, the Medical Center included several
ALAMEDA COUNTY MEDICAL CENTER
[At the Medical Center], our sons received
care that has been markedly superior to
any medical care they ever received at
high-priced, private practices. For that
matter, the care staff provided our sons is
superior to any medical service we have
ever received ourselves. [Medical Center
staff] personify to us the pinnacle of medical
professionalism. Moreover, they represent
physicians whose commitment to their
patients is inarguably their very first priority.
There is a quality of caring and generosity
unfailingly evident in the work of these
people that is extraordinary.
— Patient letter to Alameda County
Medical Center
Measure A Helps
13
patient letters praising the care they and their relatives received, as well as singling out staff who were
particularly helpful.
CONCERNS
A significant portion (approximately 1/3) of Measure A revenues is used by the Medical Center to pay off
debt and interest, primarily to the County. Much of this debt was incurred before Measure A was passed
in 2004, and there was no mention in the ballot arguments or in the campaign itself that Measure A funds
would be used in this way. For years the Medical Center has been involved in disputes about this debt and
whether it was legitimately incurred—for example, critics argue that the County was not paying its fair
share towards medical care for the indigent and uninsured.
Figure 4
AllOCATION OF MEDICAl CENTER MEASURE A FUNDS, By % IN Fy 09/10
Ambulatory 16%
ER/Urgent/Trauma 8%
Fairmont** 4%
Graduate Medical 16%
Highland Acute & Ancillaries* 18%
Behavioral Services 13%
County Loan & Capital 25%
* Highland Acute & Ancillaries includes ICU, SDU, Medical/Surgical, Perioperative, Labor & Delivery, Nursery & ICN, Oncology, and
Ancillaries (i.e., Laboratory, Radiology, etc.).
** Fairmont includes Skilled Nursing, Acute Rehab, and Therapies.
ALAMEDA COUNTY MEDICAL CENTER
I had to take my 52-year-old son to Highland Hospital. I cannot say enough about the care he
received. We were taken care of almost as soon as we walked in the door. The people in reception
were kind and polite. Within 15 minutes he was in the examining area, and within a half-hour he was
in the process of a complete examination, including blood test, X-rays, computer heart test, and all
other exams. He had a team of doctors working on him and they were all excellent. I have been in
many hospitals in my near 80 years of life, and this by far was one of the best.
— Patient letter to Alameda County Medical Center
Measure A Helps
14
Group 4: Primary Care
Board of Supervisors, $1,045,450
BHCS CBO Providers, $2,811,385
Group 1: Behavioral Health
BHCS Detox/Sobering Station, $2,121,800
MH Costs for Juv. Justice Cntr., $530,450
MH Costs for Glen Dyer Jail, Oak., $795,675
Criminal Justice Screening/In Custody
Services at Santa Rita Jail, $3,816,664
Group 2: Hospital, Tertiary Care, Other
Administration/Infrastructure Support, $212,180
Non-County Hospitals, Children’s HospIital
and St. Rose Hospital, $4,774,050
Measure A to Partially Offset Erosion in
Realignment Base Funding, $2,645,320
Group 3: Public Health
Public Health Department:
Prevention Initiative, $3,182,700
ER and On-Call Physician Reimburs., $1,591,350
Bay Area Community Services, $200,000
CBO Center, $30,000
Primary Care Community-Based
Organizations, $6,871,407
School Health Svcs. Coalition, $1,060,900
Med. Costs for Juv. Justice Cntr., $265,225
Medical Services — Healthy Communities,
Preventive Care Pathways, $265,225
REVIEW OF FY 08/09 AND FY 09/10 EXPENDITURES:
25% OF MEASURE A FUNDS ALLOCATED BY THE
ALAMEDA COUNTY BOARD OF SUPERVISORS
In FY 08/09, the 25% of Measure A revenue allocated by the Board of Supervisors (Board) totaled
approximately $29.3 million. In FY 09/10, the 25% of Measure A revenue allocated by the Board totaled
approximately $29.3 million. The Board allocated these funds as shown in the following charts
NOTE: For more details on Board allocations, see Appendix B: FY 08/09 and FY 09/10 Budget Information
and Appendix C: FY 08/09 and FY 09/10 Measure A Fund Distribution by Provider or Program.
Figure 5
MEASURE A FUNDING AllOCATED By THE BOARD OF SUPERvISORS
Group 4: Primary Care
Board of Supervisors, $1,045,450
BHCS CBO Providers, $2,811,385
Group 1: Behavioral Health
BHCS Detox/Sobering Station, $2,121,800
MH Costs for Juv. Justice Cntr., $530,450
MH Costs for Glen Dyer Jail, Oak., $795,675
Criminal Justice Screening/In Custody
Services at Santa Rita Jail, $3,816,664
Group 2: Hospital, Tertiary Care, Other
Administration/Infrastructure Support, $212,180
Non-County Hospitals, Children’s HospIital
and St. Rose Hospital, $4,774,050
Group 3: Public Health
Public Health Department:
Prevention Initiative, $3,182,700
ER and On-Call Physician Reimburs., $1,591,350
Primary Care Community-Based
Organizations, $7,004,019
School Health Svcs. Coalition, $1,060,900
Med. Costs for Juv. Justice Cntr., $265,225
Medical Services —
Preventive Care Pathways, $132,613
Fy 08/09
Fy 09/10
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FUNDS AllOCATED By THE AlAMEDA COUNTy BOARD OF SUPERvISORS
GROUP 1: BEHAVIORAL HEALTH
Alameda County Behavioral Health Care Services Community-Based Organization Providers
Alameda County Behavioral Health Care Services Detoxification/Sobering Station
Mental Health Costs for Juvenile Justice Center
Mental Health Costs for Glen Dyer Jail in Oakland
Criminal Justice Screening/In-Custody Services at Santa Rita Jail
ALAMEDA COUNTY BEHAVIORAL HEALTH CARE SERVICES COMMUNITY-BASED
ORGANIZATION PROVIDERS
FY 08/09 allocation: $2,811,385
Amount carried over from prior year allocations: 0
Expended/encumbered in FY 08/09: $2,696,527
Amount carried over to FY 09/10: 0
FY 08/09 savings transferred to reserve: $114,858
FY 09/10 allocation: $2,811,385
Amount carried over from prior year allocations: 0
Expended/encumbered in FY 09/10: $2,710,884
Amount carried over to FY 10/11: 0
FY 09/10 savings transferred to reserve: $100,501
AGENCY/PROGRAM BACKGROUND
The mission of Behavioral Health Care Services (Behavioral Health Care) is to maximize the recovery,
resilience, and wellness of all eligible Alameda County residents who are developing or experiencing serious
mental health issues, or concerns regarding substance abuse.
MEASURE A FUNDING SUMMARY
In FY 08/09, Measure A provided $2,811,385 in funding to Behavioral Heath Care community-based
organization contract providers. This amount represented 0.94 % of the overall Behavioral Health
Care budget. Measure A provided the same amount of funding to these providers in FY 09/10, which
represented 1.08% of the overall Behavioral Health Care budget. Because 85% of Behavioral Health Care
services are delivered through contracts, a great need exists to maintain system stability.
Behavioral Health Care worked with its community-based mental health and alcohol and drug providers to
establish priorities for its Measure A funding allocation. Based on these priorities, Behavioral Health Care
allocated funding to over 80 nonprofit and for-profit service providers throughout Alameda County.
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The service providers face continuously increasing business costs, such as insurance, rent, utilities, and
needed capital items. Measure A funds enabled these providers to meet some of these costs and maintain
their services. A decrease or loss of Measure A funds would force these providers to implement program
reductions, resulting in decreased services to clients.
NOTE: As an ongoing concern, the Behavioral Health Care Measure A allocation is complicated by the
agency’s “cost report process,” which results in the inability of some providers to access all of their Measure
A funds. Behavioral Health Care providers receive funding from a variety of sources, including Measure A.
The Measure A funds received are based on an allocation formula, not on actual anticipated expenditures.
After the close of the fiscal year, each provider conducts a cost report settlement to reconcile actual
expenditures against all available revenue. If a provider received more total funding than it spent, any excess
Measure A funding is the first source of revenue recouped. This money is returned to the general Measure A
fund.
In the past, the cost report settlement process proved to be too cumbersome and in conflict with the
intent of the Measure A allocation. In FY 06/07, the cost report settlement was streamlined to ensure
that providers would spend all funds for the purpose for which they were allocated in the year of the
allocation—that is, to maintain current levels of service. Even with this streamlined process, in FY 06/07
and FY 07/08, the Behavioral Health Care providers were unable to spend $2,518,639 of their Measure A
allocation. These funds were reallocated in FY 08/09 to partially offset the FY 08/09 base funding erosion
in health and mental health realignment revenues. See “Measure A Funds Used to Partially Offset Base
Funding Erosion in Health and Mental Health Realignment Revenues” for more information.
ALAMEDA COUNTY BEHAVIORAL HEALTH CARE SERVICES DETOXIFICATION/
SOBERING STATION
FY 08/09 allocation: $2,121,800
Amount carried over from prior year allocations: $2,505,965
Expended/encumbered in FY 08/09: $1,946,684
Amount carried over to FY 09/10: $2,681,081
FY 08/09 savings transferred to reserve: 0
FY 09/10 allocation: $2,121,800
Amount carried over from prior year allocations: $2,681,081
Expended/encumbered in FY 09/10: $2,121,800
Amount carried over to FY 10/11: $2,681,081
FY 09/10 savings transferred to reserve: 0
AGENCY/PROGRAM BACKGROUND
Through Measure A funding, Alameda County Behavioral Health Care Services (Behavioral Health Care)
began providing detoxification/sobering services in February 2008. The Detox/Sobering Station serves
low-income and indigent residents who are suffering from the effects of alcohol and substance overuse
and frequently co-occurring mental illnesses. These services include the following programs located on the
Fairmont Hospital Campus in San Leandro:
• Cherry Hill—a residential social model detoxification program—is a 32-bed facility serving adult
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residents. This program is a comprehensive
intervention program that includes process
groups, accommodations for non-English
speakers, 12-step groups, HIV and Hepatitis C
testing and education, assessment, post-detox
planning/placement/referral, and transportation
to treatment interviews or other related services.
Cherry Hill has a centralized telephone
screening process, and all consumers begin their
services here. This helps provide each consumer
with access to the Health Center, medical triage,
medication management, and health screenings.
Cherry Hill works closely with law enforcement
agencies and 911 emergency responders and has
established a written policy and procedures for
referrals.
Horizon Services, Inc. currently provides 35
staff, onsite 24/7, that include state-licensed
nurse coordinators. Staff have been extensively
trained in medical and mental health assessment,
de-escalation, and case management. The Health
Center and nurse coordinators are available to
monitor withdrawal and assist with medical triage and assessment to ensure safety, provide and healthy
sobering services, and conduct tuberculosis testing. Staff also provide referrals to medical/psychiatric
services as needed.
Cherry Hill offers a welcoming engagement that allows staff to assess individual needs for admission.
The center provides a supportive environment for each individual to safely withdraw and stabilize
from the effects of alcohol and/or substance overuse. Cherry Hill staff refer and support consumers
in their next step of treatment through a collaborative effort based on relationship-building among all
community resources, specifically targeting medical/psychiatric emergency departments and clinics, local
law enforcement, and community-based organizations. The ultimate goal is to enhance the quality of
living for residents, communities, and Alameda County as a whole.
• The Safe House-Sobering Center is a 24/7 facility characterized as a “very safe place to sober up,”
where as many as 50 individuals can stay an average of 4–6 hours. It offers a dignified environment
to experience withdrawal from alcohol and other drug overuse. The Center provides an alternative to
the criminalization of these behaviors and helps avoid unnecessary utilization of the County hospital’s
emergency rooms. The goal of the Safe House-Sobering Center is to provide a safe short-term monitored
space for inebriates to recover from an episode of alcohol and/or substance overuse.
• The Transport Van Program services the Safe House-Sobering Center through a multi-system transport
approach. Several vans, staffed with an emergency medical technician (EMT) and an outreach worker,
pick up individuals throughout Alameda County and take them to the Safe House. Additionally, as part of
a planned ramp-up approach, law enforcement agencies are authorized to bring appropriate inebriates to
the Safe House for services.
MEASURE A FUNDING SUMMARY
Cherry Hill Detox and Safe House-Sobering Center are 100% funded by Measure A. Neither program has
any additional sources of funding.
DETOX/SOBERING STATION
As a 25-year-old, with over five years of
consistent substance use, “Will” saw few
options for his future. Having visited the
Cherry Hill Detox/Sobering Station several
times, he finally completed detox and was
accepted into a residential program. After
being clean and sober for 9 months, Will
came back to Cherry Hill as a volunteer.
After 3 months he is still volunteering, and
he stands as a role model for detox and
post-detox recovery.
Measure A Helps
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HIGHLIGHTS
In FY 08/09, Cherry Hill saw a total of 2,426 admissions with the average length of stay of 3–4 days. The
facility was at capacity most days of all months of the fiscal year, with an active wait list totaling 4,184.
Clients were referred from 12 hospitals, law enforcement, alcohol and other drug programs, and mental
health treatment programs, as well as “self-referral.” A total of 17 staff operated the facility 24/7. There was
timely access, meaning no waiting period for those accepted. Reduced medication abuse occurred among
those admitted.
At the Safe House-Sobering Center, a total of 1,229 admissions (average 3 per day) occurred in FY 08/09,
with an average length of stay of 5 hours. A total of 7.5 full-time equivalent staff (FTEs) operated the facility
24/7. Program staff feel that the Safe House reduced hospital Emergency Department crowding, although
no objective data were reported.
In FY 09/10, Cherry Hill provided a total of 6,596 services (an average of 550 per month). The average
length of stay was 3–4 days, with the facility at capacity most days throughout the year. There was a
significant decrease in the waitlist due to the use of the Sobering Center as a service entry point. Of those
admitted to the Sobering Center, 33% moved on to Detox. Thanks to outreach to other service providers
(community-based organizations, physical/mental health, housing), almost 100% of individuals in the
program received referrals to outside agencies.
CONCERNS
As an overall concern, the stated program objectives are not measurable, making it difficult to evaluate the
program for any progress.
Because reporting for FY 08/09 and FY 09/10 used different metrics, it is hard for the Committee to
determine if the programs have shown either maintenance of or improvement in services over the two-year
reporting period.
In FY 08/09, the Sobering Center as a standalone entity was found not to be cost-effective. A new blended
approach to detoxification services was planned and implemented in FY 09/10. However, in FY 09/10, no
progress report was provided on the Safe House-Sobering Center, and no figures were provided on actual
costs encumbered.
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MENTAL HEALTH COSTS FOR JUVENILE JUSTICE CENTER
FY 08/09 allocation: $530,450
Amount carried over from prior year allocations: 0
Expended/encumbered in FY 08/09: $530,450
Amount carried over to FY 09/10: 0
FY 08/09 savings transferred to reserve: 0
FY 09/10 allocation: $530,450
Amount carried over from prior year allocations: 0
Expended/encumbered in FY 09/10: $530,450
Amount carried over to FY 10/11: 0
FY 09/10 savings transferred to reserve: 0
AGENCY/PROGRAM BACKGROUND
Measure A funds help support provision of
behavioral health care services to youth detained
in Alameda County Juvenile Hall. This enables
provision of daily behavioral health care services
to youth detained in all living units of the new
Alameda County Juvenile Justice Center. In FY
08/09 approximately 3,285 youth were booked
into the facility. On any given day, the living units
can house 250–300 youth, with an average stay
of 21 days per booking. The Guidance Clinic staff
served approximately 900 youth a year prior to
Measure A funding. This has since increased.
The goal of the behavioral health care services
offered at Juvenile Hall is to mitigate the mental
health issues of detained youth, including crisis
intervention and ongoing mental health support
while detained, and to provide court-ordered
mental health assessments.
MEASURE A FUNDING SUMMARY
A blended funding strategy combining Measure
A funds and Medi-Cal billings through the Early
and Periodic Screening, Diagnosis, and Treatment
(EPSDT) program enabled Behavioral Health Care
Services to increase the Juvenile Hall guidance
clinic staffing budget to approximately $1.4
million, which translated into an additional 15.5
full-time equivalent staff (FTEs). Measure A funds
50% of the entire guidance clinic treatment staff.
JUVENILE JUSTICE CENTER
“Jeremy” came to the Juvenile Hall
Guidance Clinic because of anxiety,
depression, difficulty sleeping, and panic
attacks. The Guidance Clinic psychiatrist
prescribed medication for anxiety and
depression. Over two months, Jeremy’s
suicidal thoughts, depression, and panic
attacks decreased. When Jonathan was
transferred to Camp Sweeney, his anxiety
and depression increased. However, with
supportive therapy and medication, his
panic attacks decreased and he adjusted
to Camp Sweeney. Jeremy did extremely
well and completed a GED and was a
part of several Camp programs, including
Cornerstone, an apprenticeship program
for the building trades. When he graduated
Cornerstone, Jeremy was awarded best
student of his class. After completing the
Camp program, Jonathan was granted
an internship with Cornerstone. In August
2010, he enrolled in college in Missouri.
Measure A Helps
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In FY 09/10 the total budget for this program was $2,720,004, of which Measure A funding contributed
$530,450 (19.5%).
HIGHLIGHTS
Through the blended funding strategy, Measure A funds helped to accomplish the following:
• Mental health services provided a therapeutic environment and preventive services in the new Juvenile
Hall, with staffing in each living unit.
• The most severely emotionally disturbed youth in Juvenile Hall received specialized mental health unit
intensive day treatment services.
• Approximately 1,000 youth received services overall in FY 08/09, increasing to approximately 1,600–
1,700 in FY 09/10.
• Institutional and Behavioral Health Care staff assigned to the Juvenile Hall living units report a reduction
in negative behavior and an increase in pro-social behavior in the unit.
• Staff also report a decrease in psychiatric symptoms among youth.
• Staff were available to youth more hours each day than in the past.
• The Guidance Clinic Juvenile Hall staffing budget increased to approximately $1.4 million, which
translated into an additional 9.5 FTEs.
CONCERNS
As an overall concern, the stated program objectives are not measurable, making it difficult to evaluate the
program for any progress.
MENTAL HEALTH COSTS FOR GLEN DYER JAIL IN OAKLAND
FY 08/09 allocation: $795,675
Amount carried over from prior year allocations: 0
Expended/encumbered in FY 08/09: $795,675
Amount carried over to FY 09/10: 0
FY 08/09 savings transferred to reserve: 0
FY 09/10 allocation: $795,675
Amount carried over from prior year allocations: 0
Expended/encumbered in FY 09/10: $795,675
Amount carried over to FY 10/11: 0
FY 09/10 savings transferred to reserve: 0
AGENCY/PROGRAM BACKGROUND
Measure A funds are used to help provide appropriate mental health services screening and subsequent
treatment and placement for adult inmates at Santa Rita Jail. The program offers improved care for adults
and youth in the justice system, including assessments and timely access to medications. The ultimate goal is
to reduce potential medication abuse in the jail setting.
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MEASURE A FUNDING SUMMARY
Since FY 06/07, Measure A funds have supported expanded psychiatric services for adult inmates in the
County’s Santa Rita and North County Correctional facilities. This allocation was made to partially address
the steady increase in the inmate population coupled with the closure of the Oakland City Jail in 2005,
which led to expanded use of the Glen Dyer Jail. Measure A funds mental health services for approximately
10% of the Santa Rita Jail inmates.
In FY 09/10, the total budget for this program was $5,889,227, of which Measure A funding provided
$795,675 (13.5%).
HIGHLIGHTS
• The inmates most in need of basic mental health services are now being served in a timely manner at
intake and for basic services. This keeps Santa Rita in compliance with its jail accreditation requirements.
• In FY 08/09, 400 inmates were served and received 1,600 service units of care.
• In FY 09/10, and average of 1,100 inmates were served per month. The total number of services
provided per month to these unduplicated individuals averaged approximately 2,500.
CONCERNS
As an overall concern, the stated program objectives are not measurable, making it difficult to evaluate the
program for any progress
CRIMINAL JUSTICE SCREENING/IN-CUSTODY SERVICES AT SANTA RITA JAIL
FY 08/09 allocation: $3,816,664
Amount carried over from prior year allocations: 0
Expended/encumbered in FY 08/09: $3,816,664
Amount carried over to FY 09/10: 0
FY 08/09 savings transferred to reserve: 0
FY 09/10 allocation: $3,816,664
Amount carried over from prior year allocations: 0
Expended/encumbered in FY 09/10: $3,816,664
Amount carried over to FY 10/11: 0
FY 09/10 savings transferred to reserve: 0
AGENCY/PROGRAM BACKGROUND
During FY 08/09 and FY 09/10, the Health Care Services Agency received $3,816,664 in Measure A funds
each year as part of a budget deficit reduction plan. Rather than spreading the Measure A funds throughout
the Health Care Services Agency budget, the Board of Supervisors (Board) allocated these funds to the
Criminal Justice Screening Program. In turn, the Health Care Services Agency disbursed general fund dollars
that previously were in the Criminal Justice Screening budget throughout the Health Care Services Agency
budget. The purpose of allocating the Measure A funding to one program was to simplify the accounting of
the Measure A funds.
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MEASURE A FUNDING SUMMARY
Measure A funds were utilized to maintain staff at the Santa Rita Jail to provide criminal justice screening/
in-custody services. Staff conduct assessments of all inmates and improve care for adults in the jail settings
by providing timely access to medications. This in turn potentially reduces medication abuse at the jail.
If Measure A funds were reduced or not available, the same range of services might be provided, but at a
lower volume with a substantial backlog. Inmates with serious mental illnesses in need of treatment might
go untreated, resulting in a sharp increase in inmate suicides. The jail system might also become out of
compliance with accreditation requirements.
HIGHLIGHTS
The Criminal Justice Screening Program used Measure A funds to provide 10,175 hours of services annually,
including assessment, treatment, and discharge/release planning services, to jail inmates with serious
mental illnesses. In early 2006, the number of inmates who received mental health services averaged 200
per month. By the end of FY 08/09, this number rose to 1,100 per month.
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FUNDS AllOCATED By THE AlAMEDA COUNTy BOARD OF SUPERvISORS
GROUP 2: HOSPITAL, TERTIARY CARE, OTHER
Administration/Infrastructure Support
Children’s Hospital
St. Rose Hospital
NOTE: Alameda County Medical Center is also part of the Hospital, Tertiary Care, Other group. See
“Review of FY 08/09 and FY 09/10 Expenditures: 75% of Measure A Funds Allocated to the Alameda
County Medical Center” for a breakdown of Alameda County Medical Center Measure A funding and
expenditures.
ADMINISTRATION/INFRASTRUCTURE SUPPORT
FY 08/09 allocation: $212,180
Amount carried over from prior year allocations: 0
Expended/encumbered in FY 08/09: $185,273
Amount carried over to FY 09/10: 0
FY 08/09 savings transferred to reserve: $26,907
FY 09/10 allocation: $212,180
Amount carried over from prior year allocations: 0
Expended/encumbered in FY 09/10: $120,074
Amount carried over to FY 10/11: 0
FY 09/10 savings transferred to reserve: $92,106
AGENCY/PROGRAM BACKGROUND
This allocation provides administrative support for the management of Measure A, including but not limited
to contract development and monitoring, management of capital request for proposal (RFP) projects,
budget oversight, and staffing of the Oversight Committee.
MEASURE A FUNDING SUMMARY
Measure A funds in FY 08/09 included an allocation of $212,180, of which $185,273 was expended for
the following: Measure A Financial Manager salary and benefits, postage and other mail delivery services
for Measure A correspondence, miscellaneous office supplies, expenses related to the Oversight Committee
meetings, and printing and graphic consultant expenses for the Measure A report. The remaining unspent
$26,907 reverted back to the general Measure A account for redistribution at a later date. The allocation
for FY 09/10 was the same as the previous year, but expenditures were somewhat lower, amounting to
$120,074, for the same purposes as noted above for FY 08/09. The amount that reverted back to the
general Measure A account was $92,106.
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CHILDREN’S HOSPITAL
FY 08/09 allocation: $2,387,025
Amount carried over from prior year allocations: $135,000
Expended/encumbered in FY 08/09: $2,522,025
Amount carried over to FY 09/10: 0
FY 08/09 savings transferred to reserve: 0
FY 09/10 allocation: $2,387,025
Amount carried over from prior year allocations: 0
Expended/encumbered in FY 09/10: $2,387,025
Amount carried over to FY 10/11: 0
FY 09/10 savings transferred to reserve: 0
NOTE: See “Medical Costs for Juvenile Justice Center” for information on how funds carried over to
FY 08/09 were spent.
AGENCY/PROGRAM BACKGROUND
The mission of Children’s Hospital and Research Center Oakland is to ensure the delivery of high-quality
care for all children through regional primary and subspecialty networks, a strong education and teaching
program, a diverse workforce, state-of-the-art research programs and facilities, and nationally recognized
child advocacy efforts.
Adolescent Medicine and the School-Based Health Clinics
The Adolescent Medicine/Teen Clinic at Children’s Hospital provides comprehensive medical, psychosocial,
and psycho-biological services for kids ages 11–19. The clinic also treats females under age 11 who have
reached physical maturity and young adults up to age 24 if needed. The hospital also has an adolescent
medicine clinic nearby and two school-based clinics in or near Oakland high schools. In FY 08/09 visits for
these three programs were 11,949. Over 45% of the patients served were Medi-Cal or California Children’s
Services (CCS) patients. In FY 09/10 the number of visits totaled 6,074, of which 95.6% of the patients
were Medi-Cal or CCS patients.
Emergency Medicine
Emergency Medicine at Children’s Hospital is the region’s premier designated Level I Pediatric Trauma
Center, treating children from birth to 18 years. In FY 08/09, the emergency department saw more than
52,000 patients , of which 72.5% were Medi-Cal or CCS patients. In FY 09/10, the emergency room saw
over 53,000 total patients, of which 72.8% were Medi-Cal or CCS patients.
Center for Child Protection
The Center for Child Protection provides comprehensive medical services primarily to children and
adolescents impacted by abuse and/or exposure to violence. The Center offers acute forensic medical
evaluations, a child abuse management clinic, and inpatient consultation. It also provides clinical social work
services. The Center for Child Protection conducted 80 acute forensic medical evaluations in 2008 and 72
in 2009. The total visits for FY 08/09 were 3,212, with Alameda County residents comprising 41.7% of the
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total. For FY 09/10, total visits for these programs were 1,556, with Alameda County residents comprising
91.4% of the total.
Hematology/Oncology
The Hematology/Oncology Department is a world-class program at the forefront of treatment and research,
developing and evaluating treatments that offer the best opportunities for survival and preservation of
quality of life. Comprehensive services include programs for hemophilia, thalassemia, sickle cell disease, and
oncology. There are also programs in neuro-oncology, thrombophilia, stem cell transplantation, and bone
marrow transplantation.
Audiology
The Division of Audiology at Children’s Hospital works with children from birth to 21 years to diagnose
and treat hearing loss or impairment. The program has a specially trained team of audiologists and speech
pathologists that offer cutting-edge technology to help children improve hearing, speech, and language.
MEASURE A FUNDING SUMMARY
In FY 08/09 and again in FY 09/10, Children’s Hospital and Research Center received $2,387,025 in
Measure A funds. The State of California provided matching funds in the amount of $2,273,920 each year,
for a total of $4,660,945 in Measure A and matching funds per year. This represents approximately 1.3% of
total budgeted operating revenue.
Measure A funds primarily subsidized outpatient programs for Alameda County residents with high Medi-
Cal and CCS utilization. Measure A and matching funds provided additional support for adolescent medicine
and school-based clinics, emergency services, child protection services, hematology and oncology services,
and audiology.
Outpatient services at Children’s Hospital continue to represent the largest losses, and these five programs
all have large outpatient components. The funding of Children’s Hospital and Research Center Oakland is
consistent with the intent of Measure A funding 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.”
Figure 6
CHIlDREN’S HOSPITAl USE OF MEASURE A FUNDING TO OBTAIN MATCHING FUNDS (AllOCATION AND
MATCH AvERAGED OvER Fy 08/09 AND Fy 09/10)
$2,500,000
$2,000,000
$1,500,000
$1,000,000
$500,000
$ 0 Measure A Allocation Matching Funds
$2,387,025 $2,273,920
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ST. ROSE HOSPITAL
FY 08/09 allocation: $2,387,025
Amount carried over from prior year allocations: 0
Expended/encumbered in FY 08/09: $2,387,025
Amount carried over to FY 09/10: 0
FY 08/09 savings transferred to reserve: 0
FY 09/10 allocation: $2,387,025
Amount carried over from prior year allocations: 0
Expended/encumbered in FY 09/10: $2,387,025
Amount carried over to FY 10/11: 0
FY 09/10 savings transferred to reserve: 0
AGENCY/PROGRAM BACKGROUND
St. Rose Hospital is a 175-bed nonprofit independent hospital that provides critical access to emergency,
inpatient, and outpatient services for low-income, underinsured populations in central and southern
Alameda County. St. Rose Hospital plays a critical role in providing top-quality medical services to Medi-Cal
beneficiaries. It provides care to a large portion of uninsured patients through the hospital and pediatric
clinics.
MEASURE A FUNDING SUMMARY
In FY 08/09 and again in FY 09/10, St. Rose Hospital received $2,387,025 in Measure A funds, which
represents about 2% of its overall budget. St. Rose received federal matching funds of at least $1,193,512
in each fiscal year. The Measure A funds allow St. Rose hospital to continue serving as a safety net hospital
to the low-income population in Alameda County. The funds are used almost exclusively for maintaining
existing services at current levels.
HIGHLIGHTS
Measure A funds contributed to the following key accomplishments:
• Began construction of 30 medically monitored beds, to be completed in 2011
• Completed required hospital seismic retrofit
• Completed installation of modern Radiology Picture Archiving and Communications System
• Expanded the size of the medical staff through aggressive recruitment
• Continued compliance with State mandates required from St. Rose Hospital’s disaffiliation with Via Christi
health systems
• Partnered with Delphi Healthcare Partners to develop a new OB/GYN hospital program
• Selected by the California Department of Public Health to participate in a Percutaneous Coronary
Intervention pilot program
• Developed a state-of-the-art imaging center in partnership with local physicians to offer comprehensive
diagnostic services to the community at minimal cost to the hospital.
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Figure 7
ST. ROSE HOSPITAl USE OF MEASURE A FUNDING TO OBTAIN MATCHING FUNDS (AllOCATION AND
MATCH AvERAGED OvER Fy 08/09 AND Fy 09/10)
$2,500,000
$2,000,000
$1,500,000
$1,000,000
$500,000
$ 0 Measure A Allocation Matching Funds
$2,387,025
$1,193,512
MEASURE A FUNDS USED TO PARTIALLY OFFSET BASE FUNDING EROSION IN
HEALTH AND MENTAL HEALTH REALIGNMENT REVENUES
FY 08/09 allocation: $2,645,320
Amount carried over from prior allocation: 0
Expended/encumbered in FY 08/09: $2,645,320
Amount carried over to FY 09/10: 0
FY 08/09 savings transfer to reserve: 0
NOTE: This offset occurred in FY 08/09 only.
AGENCY/PROGRAM BACKGROUND
In FY 08/09, the Alameda County Health Care Services Agency experienced unprecedented shortfalls in
health and mental health realignment revenues. These revenues are derived from vehicle license fees and
sales tax receipts. Each county receives a certain percentage of the total statewide receipts on a monthly basis
according to a set formula.
Based on the realignment revenues received in April 2009, the Health Care Services Agency projected a
loss in realignment revenue totaling $14.1 million. In order to mitigate this loss, each Health Care Services
Agency department—Administration/Indigent Health, Public Health, Behavioral Health, and Environmental
Health—was assigned a budget reduction target. The total of all targets was $8,283,024. The departments
achieved their targets through the enactment of a hard hiring freeze and subsequent identification of
essential positions requiring Agency Director approval to fill; elimination of all nonessential purchases;
permanent reductions in County-operated services that the State would no longer fund; additional
leveraging of revenue whenever possible; and so on.
MEASURE A FUNDING SUMMARY
On June 2, 2009, the Board of Supervisors approved that $2,645,320 in Measure A revenue be used
to partially offset the remaining shortfall of $5,816,976. This transfer of funding is not considered
supplantation, because the Measure A revenue was not used to augment a loss in County general fund
revenue; it was instead used to address the erosion of base realignment funding. Without this transfer,
provider contracts and resulting services would have been reduced substantially in FY 09/10.
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FUNDS AllOCATED By THE AlAMEDA COUNTy BOARD OF SUPERvISORS
GROUP 3: PUBLIC HEALTH
Alameda County Public Health Department: Prevention Initiative
Emergency Room and On-Call Physician Reimbursement
Bay Area Community Services
Center for Community Benefit (CBO Center)
ALAMEDA COUNTY PUBLIC HEALTH DEPARTMENT: PREVENTION INITIATIVE
FY 08/09 allocation: $3,182,700
Amount carried over from prior year allocations: 0
Expended/encumbered in FY 08/09: $3,159,960
Amount carried over to FY 09/10: 0
FY 08/09 savings transferred to reserve: $22,740
FY 09/10 allocation: $3,182,700
Amount carried over from prior year allocations: 0
Expended/encumbered in FY 09/10: $3,182,700
Amount carried over to FY 10/11: 0
FY 09/10 savings transferred to reserve: 0
AGENCY/PROGRAM BACKGROUND
The Alameda County Public Health Department Prevention Initiative operates in the context of an overall
vision of comprehensive health and a developing strategic plan aimed at reducing health disparities among
various geographic and other communities within the Measure A target populations. Measure A funds under
the Public Health Department Prevention Initiative supported three main priorities: chronic disease and
injury prevention, health inequities and community capacity-building, and obesity prevention and school
health. To determine these priorities, department staff conducted an internal assessment process that led to
the identification of over 20 key service areas where significant service disparities exist in the County.
MEASURE A FUNDING SUMMARY
For the FY 08/09 and FY 09/10, Measure A funding in the three priority areas was as follows:
PRIORITY FY 08/09 FY 09/10
Chronic Disease and Injury Prevention $949,784 $959,698
Health Inequities and Community Capacity-Building $1,285,438 $1,214,425
Obesity Prevention and School Health $924,738 $1,008,577
29
HIGHLIGHTS
In FY 08/09 and FY 09/10, the Public Health Department Prevention Initiative used Measure A funds for
the following.
Chronic Disease and Injury Prevention
• The Asthma Start program led to a reduction in both asthma attacks and emergency room visits.
• The Diabetes Program taught self-management classes in English, Spanish, Chinese, Farsi, and Hindi and
offered in-home support services.
• Project New Start provided no-cost tattoo removal, educational and vocational services, and nutritious
food to former gang member youth.
• The Dental Program performed outreach and education and enrolled kids in the Healthy Teeth prevention
program.
• Tiburcio Vasquez Health Center provided diabetes education to Spanish-speaking adults in South County.
• Bay Area Black United Fund provided yoga classes to low-income African-American youth.
• Emergency Medical Services worked with the Social Services Agency to implement fall risk-reduction
strategies for seniors, developed pipeline project tools to increase program access, and worked to increase
access to emergency medical services through Alameda County by leveraging funding from State Senate
measure SB 12.
Health Inequities and Community Capacity-Building
• The Nursing Program partnered with the Oakland Unified School District to conduct immunization
clinics and provided resources to operate community time-banking programs.
• Community Assessment Planning and Evaluation (CAPE) continued to work with Sobrante Park residents
to improve the neighborhood streetscape and reduce drug dealing and violence.
• CAPE also worked with West Oakland residents to abate blighted properties, collaborated with the YMCA
and Hoover Elementary School to implement an after-school activity center, and established a mentorship
program to reduce the number of suspensions at Hoover.
• Healthy Passages implemented the Adolescent Reproductive Health and Social Marketing Initiative.
• Children’s Hospital provided asthma education to 50 children diagnosed with asthma and to their
caretakers.
• The HIV Prevention program increased access to high-quality care and treatment services to people with
HIV/AIDS.
• The Public Health Department collaborated with five Medi-Cal primary care providers to develop and
implement an immunization registry.
Obesity Prevention and School Health
• The City of Berkeley operated a referral system for families, teachers, and school staff to refer children
and families to the Berkeley School Nurses Project.
• Nutrition Services provided the Soda-Free Summer social marketing campaign, Healthy Living Councils,
community mini-granting, and support for school wellness policy development and implementation.
30
EMERGENCY ROOM AND ON-CALL PHYSICIAN REIMBURSEMENT
FY 08/09 allocation: $1,591,350
Amount carried over from prior year allocations: $150,000
Expended/encumbered in FY 08/09: $1,591,350
Amount carried over to FY 09/10: $150,000
FY 08/09 savings transferred to reserve: 0
FY 09/10 allocation: $1,591,350
Amount carried over from prior year allocations: $150,000
Expended/encumbered in FY 09/10: $1,601,328
Amount carried over to FY 10/11: $140,022
FY 09/10 savings transferred to reserve: 0
AGENCY/PROGRAM BACKGROUND
Measure A funds paid for the cost of emergency care for over 17,000 indigent and uninsured patients
in FY 08/09 and over 16,000 indigent and uninsured patients in FY 09/10 treated at emergency rooms
throughout Alameda County. The law requires hospital emergency rooms to treat all patients needing urgent
care, but doctors receive only partial payment—in any—for emergency services rendered to these patients.
Measure A helps fill the gap created by state and federal policy. Funding for emergency room care provided
by physicians decreased significantly in 1963, when the California Legislature transferred financial
responsibility for providing care to indigent adults from the state to counties. Payments to private physicians
for emergency care of 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.
MEASURE A FUNDING SUMMARY
In FY 08/09 and FY 09/10, the Alameda County Public Health Department reimbursed emergency room
and on-call physicians a total of $1,409,300 and $1,409,914, respectively, using Measure A funds. This
represents approximately 88.56% of the total Measure A allocation of $1,591,350 per year. The remaining
11.44% was used for indirect costs each year.
Payments were made to more than 40 medical groups and individual physicians in both FY 08/09 and FY
09/10. In FY 08/09, a total of 17,367 claims were paid. In FY 09/10, the total number of paid claims was
16,030.
31
BAY AREA COMMUNITY SERVICES
FY 08/09 allocation: $200,000
Amount carried over from prior year allocations: 0
Expended/encumbered in FY 08/09: $200,000
Amount carried over to FY 09/10: 0
FY 08/09 savings transferred to reserve: 0
NOTE: Bay Area Community Services did not receive Measure A funding in FY 09/10. In FY 09/10,
$103,000 in funding that had been encumbered in FY 08/09 was liquidated. This amount resulted in a
savings that was transferred to the Measure A reserve in FY 09/10.
AGENCY/PROGRAM BACKGROUND
Bay Area Community Services is a nonprofit organization dedicated to developing stable, supportive services
that promote community-based independent living for marginalized adults. Bay Area Community Services
provides adult senior care and mental health services. Adult senior services include adult day care centers,
affordable in-home care, an innovative program for those with early memory loss, and transportation
services. Mental health services help clients understand and discuss their illness, recognize and manage their
symptoms, and receive the right mix of medical and counseling services to maximize the quality of their
lives.
MEASURE A FUNDING SUMMARY
The Measure A allocation for FY 08/09 was $200,000, which funded the provision of home-based meals to
frail seniors living in their own homes in Alameda County.
HIGHLIGHTS
In FY 08/09, Bay Area Community Services used Measure A funds for the following:
• Served 13,333 additional meals to seniors
• Provided over 100 frail seniors with assessments to determine medical needs
• Provided drivers who not only delivered meals but also reported on seniors who needed follow-up
medical assessments
• Hired case managers who followed up to determine the ability of seniors to live independently.
CONCERNS
The funding received from Measure A was a one-time allocation to assist Bay Area Community Services
address a financial crisis and preserve services to a vulnerable population. Bay Area Community Services
was not able to verify whether or not recipients of the Measure A-funded services were uninsured or
underinsured. While the Oversight Committee understands that the recipients of these services were likely
to be eligible, the Committee would prefer to have eligibility verified. The Committee is also concerned that
this Measure A allocation may be a case of Measure A funding an activity in order to address a community-
based organization’s financial crisis. The intent of Measure A funding is to ensure the continuance or support
the expansion of a specific program or activity itself.
32
CENTER FOR COMMUNITY BENEFIT (CBO CENTER)
FY 08/09 allocation: $30,000
Amount carried over from prior year allocations: 0
Expended/encumbered in FY 08/09: $30,000
Amount carried over to FY 09/10: 0
FY 08/09 savings transferred to reserve: 0
NOTE: Center for Community Benefit did not receive Measure A funding in FY 09/10.
AGENCY/PROGRAM BACKGROUND
Center for Community Benefit (CBO Center) provides capacity-building services to community-based
organizations in Alameda County.
MEASURE A FUNDING SUMMARY
In FY 08/09, the Board of Supervisors approved a Measure A allocation of $50,000 ($30,000 from the
general Measure A fund and $20,000 from Supervisor Gail Steele’s Measure A discretionary account) to
the Center for Community Benefit. Funds were used to provide capacity-building services to executive
directors, board members, and senior management staff from 75 community-based organizations that offer
health services in Alameda County. Services included skills-building workshops, facilitated roundtables on
leadership, management and fund development, peer coaching circles, consulting and information, and
referrals to nonprofit consultants.
33
FUNDS AllOCATED By THE AlAMEDA COUNTy BOARD OF SUPERvISORS
GROUP 4: PRIMARY CARE
Primary Care Community-Based Organizations
School Health Services Coalition (Formerly School-Based Health Centers)
Medical Costs for Juvenile Justice Center
Healthy Communities, Inc.
Preventive Care Pathways
Other Capital (Alameda Hospital)
2007 Capital Investment in the County’s Health Care Safety Net
PRIMARY CARE COMMUNITY-BASED ORGANIZATIONS
FY 08/09 allocation: $6,871,407
Amount carried over from prior year allocations: $304,500
Expended/encumbered in FY 08/09: $6,825,538
Amount carried over to FY 09/10: $304,500
FY 08/09 savings transferred to reserve: $45,869
FY 09/10 allocation*: $7,004,019
Amount carried over from prior year allocations: $304,500
Expended/encumbered in FY 09/10: $7,076,957
Amount carried over to FY 10/11: $231,562
FY 09/10 savings transferred to reserve: 0
*NOTE: The FY 09/10 total allocation includes an allocation for Healthy Communities which was
previously funded under medical services for Oakland.
AGENCY/PROGRAM BACKGROUND
The Primary Care Community-Based Organizations (comprised of the County Medically Indigent Services
Plan (CMSP) and Alameda County Excellence (ACE)) focus on prevention and proactive health management
for indigent residents in Alameda County. Their objectives are to decrease per-patient expenditures by
reducing emergency room use, provide an equitable and uniform method of payment for health services,
provide consistency in the way eligibility standards are applied, develop a standardized demographic
database, and empower patients to take a more active role in their health care.
MEASURE A FUNDING SUMMARY
Primary Care Providers were contracted through Measure A to provide the following visits to Alameda
County indigent patients in FY 08/09 and FY 09/10:
34
FY 08/09 PROVIDER
CONTRACTED
VISITS
ACTUAL
VISITS VARIANCE
Asian Health Services 9,540 12,871 +3,331
Axis Community Health 5,522 6,575 +1,053
Bay Area Consortium for Quality Healthcare 1,267 984 -283
La Clinica de la Raza 18,301 20,219 +1,918
LifeLong Medical Care 9,650 15,454 +5,804
Native American Health Center 4,379 5,642 +1,263
Tiburcio Vasquez Health Center 8,362 10,758 +2,396
Tri-City Health Center 5,107 6,168 +1,061
West Oakland Health Center 12,457 12,966 +509
FY 09/10 PROVIDER
CONTRACTED
VISITS
ACTUAL
VISITS VARIANCE
Asian Health Services 9,540 12,780 +3,240
Axis Community Health 5,522 9,504 +3,982
Healthy Communities 3,855 2,935 -920
La Clinica de la Raza 18,301 16,021 -2,280
LifeLong Medical Care 9,650 11,684 +2,034
Native American Health Center 4,379 3,677 -702
Tiburcio Vasquez Health Center 8,362 10,980 +2,618
Tri-City Health Center 5,107 10,586 +5,479
West Oakland Health Center 12,457 12,315 -142
HIGHLIGHTS
The Primary Care clinics saw a total of 28,344 unduplicated patients in FY 08/09 and 29,055 unduplicated
patients in FY 09/10.
The vast majority of Primary Care clinics exceeded the number of Measure A-contracted visits, by an average
of 35%. While the actual visits for a small number of clinics was lower than the contracted number (by
a smaller average of 15%), the Committee recognizes that some number of these clinics may have had
legitimate financial or other constraints contributing to the lower number of services provided.
Furthermore, in FY 09/10, the reporting requirements for contracted indigent providers became much
more stringent, and the requirements were not completely finalized until the middle of the year. The
Health Care Services Agency made a commitment to all providers that if they didn’t meet their performance
standards regarding the contracted number of visits, the Agency would analyze each situation individually
and not penalize them because the data set was not provided to them in a timely manner.
Specifics on those organizations that did not meet their contracted visit targets in FY 09/10 are as follows:
• Healthy Communities received full payment as it was determined that as a startup clinic it would be
virtually impossible for them to meet their visit target in the first year. The organization is on track to
meet 100% of its targeted visit count in FY 10/11.
• La Clinica de la Raza received full payment as it was technically unable to resubmit its rejected or
disallowed visits, and the Health Care Services Agency felt it was unfair to penalize them.
35
• Native American Health Center has not received their final FY 09/10 payment.
• West Oakland Health Center received full payment as per the contract requirements they were required to
reach 95% of their visit target. They provided 98.9% of their target.
NOTE: The contract for Bay Area Consortium for Quality Health Care was terminated in FY 08/09 (effective
11/1/08). The organization received $138,877 of their $333,306 allocation.
SCHOOL HEALTH SERVICES COALITION
(FORMERLY SCHOOL-BASED HEALTH CENTERS)
FY 08/09 allocation: $1,060,900
Amount carried over from prior year allocations: $100,788
Expended/encumbered in FY 08/09: $1,038,951
Amount carried over to FY 09/10: $100,788
FY 08/09 savings transferred to reserve: $21,949
FY 09/10 allocation: $1,060,900
Amount carried over from prior year allocations: $100,788
Expended/encumbered in FY 09/10: $1,052,232
Amount carried over to FY 10/11: $109,456
FY 09/10 savings transferred to reserve: 0
AGENCY/PROGRAM BACKGROUND
The mission of the Alameda County School
Health Services Coalition (School-Based Health
Centers Program) is to improve the health, well-
being, and success of adolescents in schools by
increasing access to comprehensive, high-quality
health care services; reducing barriers to learning;
and supporting families and communities. The
Coalition provides funding to seven “lead”
agencies that operate 14 school-based health
centers. The Coalition also provides evaluation and
technical assistance services with assistance from
UC San Francisco, the Philip R. Lee Institute, and
the California School Health Center Association.
MEASURE A FUNDING SUMMARY
The Measure A allocation for FY 08/09 was
$1,060,900. The allocation for FY 09/10 was also
$1,060,900. The Alameda County School Health
Services Coalition allocated Measure A funds to
provide core funding for the seven lead agencies
to operate their 14 school-based health centers.
SCHOOL HEALTH SERVICES COALITION
“Joey” developed diabetes in 5th grade
but wasn’t diagnosed until two years
later. He struggled with his condition and
suffered frequent headaches due to low
blood sugar levels. Joey found it difficult to
focus at school and started using marijuana
to alleviate his pain and stress. Joey’s
doctor contacted the staff at his school-
based health center to help coordinate care
for Joey’s condition. Since then, a school
health center nurse has worked closely with
Joey to check his blood sugar levels daily.
Joey has started getting counseling for
his substance use and is participating in a
monthly leadership program that provides
tutoring and community service.
Measure A Helps
36
Figure 8
AlAMEDA COUNTy SCHOOl HEAlTH SERvICES (SHS) USE OF MEASURE A FUNDING TO OBTAIN lEvERAGED
FUNDS, Fy 08/09 AND Fy 09/10
$8,000,000
$7,000,000
$6,000,000
$5,000,000
$4,000,000
$3,000,000
$2,000,000
$1,000,000
$0 Measure A Allocation
FY 08/09
Leveraged Funds
FY 08/09
$1,060,900
$6,769,353
Measure A Allocation
FY 09/10
Leveraged Funds
FY 09/10
$1,060,900
$7,601,984
HIGHLIGHTS
Key accomplishments during FY 08/09 included the following:
• Provided access to on-campus, low- and no-cost services to more than 21,300 middle and high school
students in Alameda County.
• Provided 39,754 clinic visits to approximately 7,400 students. This represents approximately 35% of the
student population in schools with health centers.
• Provided 24 youth development and empowerment programs that 670 students took part in.
• Had a positive impact on the academic and personal lives of a large majority (71%) or students, based on
surveys conducted by UC San Francisco.
Key accomplishments during FY 09/10 included the following:
• Served 9,421 students (a 27% increase from FY 08/09) through a total of 46,416 visits (a 17% increase
from FY 08/09).
• Opened two new school-based health centers to serve students attending continuation high schools. The
new centers were B-Tech Health Center and Island High Health Center.
• Completed a comprehensive survey of students who participated in youth development and
empowerment programs. The majority of respondents indicated that participating in the programs
“definitely” or “somewhat” improved their communication skills, self-esteem, interpersonal skills,
presentation and public speaking skills, grades, and school attendance.
The Alameda County School Health Services Coalition was able to leverage its Measure A funding by
requiring a one-to-one cash match for each of its lead agencies. A total of $6,769,353 in additional funding
and revenue was leveraged during FY 08/09, which increased to $7,601,984 in FY 09/10, to support the
school-based health centers.
37
Figure 9
DISTRIBUTION OF MEASURE A FUNDS AllOCATED TO SCHOOl-BASED HEAlTH CENTERS
(Providers are italicized and listed beside the clinics in parentheses)
NOTE: Total allocated to School Health Services in FY 08/09 was $1,060,900; the balance of funds of $810,727 was
used for evaluation and other administrative expenses. Total allocated to School Health Services in FY 09/10 was
$1,060,900; the balance of funds of $857,787 was used for evaluation and other administrative expenses.
Alameda Family Services (Alameda and
Encinal High) $137,917 – 17%
La Clinica (Roosevelt, Tech, Tiger,
and San Lorenzo) $275,834 – 34%
Tiburcio Vasquez (Logan and
Tennyson High) $137,917 – 17%
Children’s Hospital and Research Center
Oakland (McClymonds High and Youth
Uprising) $137,917 – 17%
City of Berkeley (Berkeley High) $68,958.50 – 9%
East Bay Agency for Children (Oakland High) $52,184.22 – 6%
Fy 08/09
Alameda Family Services (Alameda and
Encinal High) $137,917 – 16%
La Clinica (Roosevelt, Tech, Tiger,
and San Lorenzo) $275,834 – 32%
Tiburcio Vasquez (Logan and
Tennyson High) $137,917 – 16%
Children’s Hospital and Research Center
Oakland (McClymonds High and Youth
Uprising) $137,917 – 16%
City of Berkeley (Berkeley High) $68,958.50 – 8%
East Bay Agency for Children (Oakland High) $52,184.22 – 6%
Fy 09/10
Health Care Services Agency
(Ashland Youth Center) $47,060 – 6%
38
MEDICAL COSTS FOR JUVENILE JUSTICE CENTER
FY 08/09 allocation: $265,225
Amount carried over from prior year allocations: $126,881
Expended/encumbered in FY 08/09: $181,881
Amount carried over to FY 09/10: 0
FY 08/09 savings transferred to reserve: $210,225
FY 09/10 allocation: $265,225
Amount carried over from prior year allocations: 0
Expended/encumbered in FY 09/10: $145,410
Amount carried over to FY 10/11: 0
FY 09/10 savings transferred to reserve: $119,815
AGENCY/PROGRAM BACKGROUND
Measure A funding is used to provide heath care services to youth at the County Juvenile Justice Center. In
FY 08/09 and FY 09/10, the Measure A allocation was used for billing services to the Victims of Crime unit
and funding a contract with the Mind Body Awareness Project, a San Francisco-based nonprofit organization
dedicated to the health and well-being of incarcerated at-risk youth. In addition, a portion of the FY 08/09
allocation was used to reimburse Children’s Hospital and Research Center of Oakland for cost overruns that
occurred in FY 07/08.
MEASURE A FUNDING SUMMARY
The Measure A allocation for FY 08/09 and FY 09/10 was $265,225 each year.
HIGHLIGHTS
In FY 08/09, the contract with Mind Body Awareness produced the following results:
• The program conducted 191 classes and served 495 unduplicated youth.
• In rating the program, participants valued the opportunity to be heard, learn to think before acting, and
learn meditation techniques. Participants expressed an interest in having more class time.
• Collaborating agencies, especially the Probation Department, have highly praised the program.
In FY 09/10, the contract with Mind Body Awareness produced the following results:
• The program conducted 258 classes and served 892 unduplicated youth.
• In collaboration with the Juvenile Justice Center, the program conducted a pilot “sleep and anxiety”
study with youth from Camp Sweeney. The participants in the Mind Body Awareness program showed a
significant reduction in anxiety, improved sleep quality, reductions in stress, and improved self-control.
The FY 08/09 investment in the Victims of Crime unit generated in excess of $250,000 in additional
revenue, which was reinvested into the provision of direct medical services. In FY 09/10, the investment in
the Victims of Crime unit generated $225,000 in additional revenue for the provision of medical services.
In FY 08/09, $135,000 in carry over funds from the non-county hospital allocation was used to augment
Children’s Hospital as the medical health care provider for youth in detention at the Juvenile Justice Center.
39
HEALTHY COMMUNITIES, INC.
FY 08/09 allocation: $132,613
Amount carried over from prior year allocations: 0
Expended/encumbered in FY 08/09: $132,613
Amount carried over to FY 09/10: 0
FY 08/09 savings transferred to reserve: 0
NOTE: In FY 09/10, Healthy Communities, Inc. became part of the Primary Care Community-Based
Organizations. See “Primary Care Community-Based Organizations” for details.
AGENCY/PROGRAM BACKGROUND
Healthy Communities, Inc. is a faith-based, nonprofit organization that was formed to address escalating
violence and health disparities in African-American communities in Oakland. The organization’s mission is
to decrease violence among and health disparities for people of color. This is accomplished by collaborating
with other community-conscious organizations, churches, businesses, and individuals. The organization’s
theme is “Reclaiming, Repairing, and Restoring Our Community.”
Healthy Communities, Inc. provides street-level health and welfare outreach services in West and East
Oakland. It is the only agency in Alameda County that offers an array of services to formerly incarcerated
men and women. In March 2009, it became the first African-American nonprofit organization to operate a
State of California-licensed medical clinic.
MEASURE A FUNDING SUMMARY
The Measure A allocation for FY 08/09 was $132,613.
HIGHLIGHTS
During the FY 08/09, Healthy Communities accomplished the following:
• Trained staff to do targeted outreach to vulnerable clients
• Hired and trained additional service providers and transportation services
• Hired an outreach worker to assist the operation
• Conducted presentations with partner agencies that provide client services
• Negotiated a laboratory and pharmacy contract for the agency
• Obtained a clinic license and contracted with the California Board Certified Physicians for consultation
services.
Additionally, Healthy Communities, Inc. partnered with the LifeLong Medical Center and Preventive Care
Pathways and was awarded the Open Access County Medically Indigent Services Plan (CMSP) contract and
the Measure Y Violence Prevention contract with the City of Oakland.
40
PREVENTIVE CARE PATHWAYS
FY 08/09 allocation: $132,613
Amount carried over from prior year allocations: 0
Expended/encumbered in FY 08/09: $132,613
Amount carried over to FY 09/10: 0
FY 08/09 savings transferred to reserve: 0
FY 09/10 allocation: $132,613
Amount carried over from prior year allocations: 0
Expended/encumbered in FY 09/10: $132,482
Amount carried over to FY 10/11: 0
FY 09/10 savings transferred to reserve: $131
AGENCY/PROGRAM BACKGROUND
Preventive Care Pathways, in conjunction with
the James A. Watson Wellness Center, provides
disease prevention, intervention, and treatment
to at-risk members of the community. Program
objectives include prevention and treatment
of disease through education and screening
services, as well as treatment of cardiovascular
disease, hypertension, diabetes, cancer, STDs,
HIV infection, pulmonary disease, mental health
issues, and substance abuse.
Preventive Care Pathways collaborates with
numerous agencies such as Healthy Oakland,
Alameda County Medical Center, Sutter Health,
Sinkler Miller, Samuel Merritt, LifeLong Medical
Center, Touro University, and other organizations.
MEASURE A FUNDING SUMMARY
The Measure A allocation for FY 08/09 and
FY 09/10 was $132,613 each year. Measure A
funds allowed the James A. Watson Wellness Center
to expand the scope of its indigent care services
to East Oakland, West Oakland, and Berkeley, and
throughout Alameda County. With Measure A funds, Preventive Care Pathways was able to provide a stronger
safety net for at-risk populations by expanding education to the at-risk community, expanding its capacity
to assist the most vulnerable population in Alameda County (African-Americans), and assisting prisoners
re-entering the general population.
PREVENTIVE CARE PATHWAYS
“Beth” had no insurance and no primary
care physician. The family noticed a change
in her bathroom use, appetite, and energy
level. A family member heard about the
program at the clinic and brought Beth in
for treatment. Beth was diagnosed with
diabetes that was not being controlled
by diet and or medication. As a result
of Measure A funding, Beth was able to
obtain proper treatment, education on diet
control, exercise, and correct medication.
Without the program, she would have
eventually experienced severe medical
problems.
Measure A Helps
41
HIGHLIGHTS
During FY 08/09 and FY 09/10, Preventive Care Pathways, in conjunction with the James A. Watson
Wellness Center, accomplished the following:
• Provided education to at-risk populations
• Increased health screening services
• Increased disease assessment and management services
• Experienced a 1.5% increase in patient visits
• Assisted almost 1,000 uninsured patients.
OTHER CAPITAL (ALAMEDA HOSPITAL)
FY 08/09 allocation: 0
Amount carried over from prior year allocations: $100,000
Expended/encumbered in FY 08/09: $100,000
Amount carried over to FY 09/10: 0
FY 08/09 savings transferred to reserve: 0
NOTE: In FY 09/10, $4,345 in funding that had been encumbered in FY 08/09 was liquidated. This
amount resulted in a savings that was transferred to the Measure A reserve in FY 09/10.
AGENCY/PROGRAM BACKGROUND
In 2006, a city parcel tax initiative mandated Alameda Hospital to provide emergency services to Alameda
residents. To comply with this mandate, the hospital needed to upgrade its pulmonary function and EEG
system and purchase a new ultrasound system in order to provide better service in an efficient manner.
MEASURE A FUNDING SUMMARY
In FY 08/09, the Board of Supervisors approved a Measure A allocation of $100,000 that allowed Alameda
Hospital to purchase capital equipment to support these mandated services.
42
2007 CAPITAL INVESTMENT IN THE COUNTY’S HEALTH CARE SAFETY NET
FY 08/09 allocation: 0
Amount carried over from prior year allocations: $1,340,285
Expended/encumbered in FY 08/09: $993,438
Amount carried over to FY 09/10: $346,847
FY 08/09 savings transferred to reserve: 0
FY 09/10 allocation: 0
Amount carried over from prior year allocations: $346,847
Expended/encumbered in FY 09/10: $262,854
Amount carried over to FY 10/11: 0
FY 09/10 savings transferred to reserve: $83,993
AGENCY/PROGRAM BACKGROUND
In FY 07/08, the Board of Supervisors (Board) allocated $3 million of Measure A revenue for a Capital
Investment fund. The Board directed the Health Care Services Agency to develop and release a request for
proposals (RFP), review the proposals, and submit recommendations for funding. In February 2008, the
Board ultimately approved funding for thirty-eight capital projects, which required the execution of a
contract for each project.
MEASURE A FUNDING SUMMARY
Approximately $1.6 million of the $3.0 million total allocation was expended/encumbered in FY
07/08. The balance of funds was carried over into FY 08/09, and in that year, $993,438 was expended/
encumbered. By FY 09/10 $346,847 remained, of which $262,854 was expended/encumbered. The
balance of $83,993 was liquidated and transferred as savings to the Measure A reserve.
43
FUNDS AllOCATED By THE AlAMEDA COUNTy BOARD OF SUPERvISORS
GROUP 5: BOARD OF SUPERVISORS DISCRETIONARY ALLOCATIONS
BOARD OF SUPERVISORS DISCRETIONARY ALLOCATIONS
FY 08/09 allocation: $1,045,450
Amount carried over from prior year allocations: $660,734
Expended/encumbered in FY 08/09: $455,974
Amount carried over to FY 09/10: $1,250,210
FY 09/10 allocation: $1,045,450
Amount carried over from prior year allocations: $1,250,210
Expended/encumbered in FY 09/10: $897,606
Amount carried over to FY 10/11: $1,398,053
AGENCY/PROGRAM BACKGROUND
On December 14, 2004, the Board of Supervisors (Board) took action to authorize the discretionary
allocation of $100,000 per district per year, beginning in FY 04/05, for Measure A-related services. On
October 9, 2007, the Board approved a 3% cost of living adjustment (COLA) for all programs receiving
Measure A allocations; increased the Board discretionary allocation from $100,000 to $200,000; and
incorporated a COLA into future allocations.
MEASURE A FUNDING SUMMARY
In FY 08/09 and FY 09/10, the budgeted allocation per district was $209,090 each year.
The appropriation and associated contracts recommended by the individual Supervisors require Board
approval. Supervisors may submit allocation requests at any time during the fiscal year and may carry over
unspent or unallocated funds designated for their district from one fiscal year to the next. The discretionary
Board appropriations must meet all of the administrative and policy requirements of Measure A.
The Board allocations reflect a growing expansion of health care services into healthy living, wellness,
and prevention initiatives, aimed at preventing illness and injury and their associated health care impacts
and costs, and promoting fitness, safety, and nutrition. They also address recognition of the health care
disparities caused by language barriers, poverty, and violence in neighborhoods, as well as the trauma of
violence for individuals and families.
In terms of allocations from multiple Supervisors, HEPPAC and Spectrum have received funds in each
Measure A funding year from Supervisors Lai-Bitker, Steele, and Miley. Sometimes a provider will approach
specific Supervisors (or their staff) with funding requests based on the geographic area to which they are
providing services. Sometimes the Supervisors express a joint interest in funding a program. And other
times, the Health Care Services Agency may make a recommendation to the Supervisors based on an unmet
need.
44
HIGHLIGHTS
(funded years shown in parentheses after each recipient agency
name)
It appears that the Board allocation recipients
spent the funds according to the Measure A
criteria.
Each member of the Board of Supervisors
recommended allocations for approval by the
Board as a whole. In both FY 08/09 and 09/10,
the budgeted allocation per district was $209,090.
Over the period of this report, there were 42
contracts for services for youth, children, seniors,
and the general population from the allocations.
During this period, the Committee noted an
increased focus on healthy living, wellness, and
prevention initiatives.
Senior Services
• The following agencies provided planning,
education, and training for seniors in fall
prevention, proper use of medication, and
other home safety issues: Horizon Services
Inc./CommPre (FY 08/09), LIFE ElderCare, Inc.
(FY 08/09), Senior Support Program of the Tri-Valley (FY 08/09), and Spectrum (FY 08/09).
• SOS/Meals on Wheels (FY 09/10) provided nutritious meals to unincorporated areas.
• Measure A provided partial funding for United Seniors of Oakland and Alameda’s Healthy Living Festival
(FY 09/10).
• Alameda Alliance for Health (FY 09/10) provided 100 hours of in-person Spanish or Vietnamese
interpreter services in health care settings, focusing on low-income seniors and persons with disabilities.
Children/Youth Services
• East Bay Asian Youth Center’s “Shop 55” at Oakland High School (FY 08/09, FY 09/10), by leveraging
Measure A funds, delivered medical, behavioral health, health education, and youth development services
to 45% of the student population. Services more than doubled each year.
• St. Rose Hospital Silva Pediatric Clinic (FY 08/09) experienced 2,000 more patient visits in FY 08/09
than in FY 07/08, providing preschool immunizations, well baby care, dental services, urgent care, and
mental health services to underserved and underinsured children.
• School-Based Mental Health Services/San Lorenzo (FY 08/09) was able to hire two full-time mental
health workers at Edendale and Bohannon Middle Schools.
• Tiburcio Vasquez Health Center (FY 08/09, FY 09/10) expanded its health education and case
management services to high-risk youth and their parents/guardians, resulting in decreased truancy and
discipline issues. In FY 09/10, the agency attributed a 20% reduction in pregnancies to its expanded
health education.
• Tri-Valley Community Foundation (FY 08/09) hired two bilingual, bicultural community health workers
for students and their families.
• Oakland Schools Foundation/Mental Health Collaborative-Fruitvale Schools (FY 09/10) provided mental
health services to address trauma associated with poverty, discrimination, lack of services, and daily
UNITED SENIORS OF OAKLAND AND
ALAMEDA
As part of the Healthy Living Festival, each
year East Oakland Youth Development
Center (EOYDC) brings approximately 100
youth to assist and interact with seniors at
the event. Youth ranging from 6 to 17 years
old deliver lunches to seniors, assist seniors
in navigating, access resources throughout
the event, and finally interview seniors on
the success of the event. Event staff is told
consistently by the attending youth that
they are amazed that some of the seniors
are that healthy and active, aware and
proactive regarding their health. Youth
walk away from the event with a better and
healthier vision of what aging means.
Measure A Helps
45
exposure to violence in the community.
• 100 Black Men of the Bay Area (FY 09/10)
offered fitness and nutrition education
programs for youth.
• Las Positas College Student Health Center (FY
09/10) provided mental health internships and
emergency medical care services.
• TransForm/Safe Routes to Schools Partnership
(FY 09/10) encouraged students to walk to
school to address childhood obesity in low-
income neighborhoods.
Other Healthy Living, Wellness, and Prevention
Initiatives
• HIV Education & Prevention Project of Alameda
County (FY 08/09, FY 09/10) reported an
increase in savings of emergency room costs
through increased access to its emergency
wound care and syringe exchange programs for
intravenous drug users.
• The Eden Area Livability Initiative (FY 08/09,
FY 09/10) completed the Community Profile
document, which is being used for both Public
Health and School-Based Health Center planning and grant proposals to serve low-income residents.
• Mandela MarketPlace (FY 09/10) completed design development for a grocery retail/healthy community
center to low-income residents in unincorporated Alameda County (Cherryland and Ashland) to provide
wholesome food and nutrition education to combat obesity, diabetes, and high blood pressure.
• Open Heart Kitchen (FY 09/10) provided 833 meals per month to low-income Tri-Valley residents.
• Safe Alternatives to Violent Environments (FY 09/10) offered counseling for domestic violence victims
and kids. The agency used Measure A funds to leverage more than $100,000 in additional funding.
• Tri-Valley Haven (FY 09/10) hired a Life Skills instructor/counselor for victims of domestic violence.
• Public Health Department/Community Health Services Office of Dental Health (FY 09/10) promoted
oral health through community outreach and case management training and assistance in Alameda.
• Asian Health Services (FY 09/10) counseled young Southeast Asian-American women and girls at risk of
sex exploitation, and increased its clinical capacity to provide health services to sexually exploited youth.
• Healthy Communities, Inc./Save A Life Wellness Center (FY 09/10) provided health, mental health, and
transportation services to the indigent population in West Oakland, included mental health services to
more than 300 patients and primary health care representing more than 3,800 County Medical Services
Program patient visits.
• Healthy Communities, Inc. (FY 09/10), in partnership with the faith community, initiated the
Community of Hope Coalition. In response to a violent murder, the Coalition provides community
outreach and referral services from a modular unit in Hayward, with the ultimate goal of providing
health and nutrition services.
Other Services
• Abode Services (Formerly Tri-City Homeless Coalition) (FY 08/09), through its HOPE Project, expanded
its ability to take primary and mental health care and case management to persons without housing by
funding a mobile health van driver.
• Center for Community Benefit Organizations (FY 08/09, FY 09/10) trained recipients of Measure A
SAFE ALTERNATIVES TO VIOLENT
ENVIRONMENTS (SAVE)
“June” ran away from her abusive husband,
bringing her five-month-old son to SAVE’s
emergency shelter. June used SAVE’s
individual and group counseling services
to deal with the post-traumatic stress that
she suffered. After receiving these services
for some time, she commented: “I could
never have made it without your help. I
have regained my self-esteem and pride,
and most important, I am healing from the
trauma I went through and becoming a
better person for myself and my son.”
Measure A Helps
46
allocations and other nonprofits on improving
their effectiveness, raising funds, and
developing other skills to survive increased
demands and reduced resources.
• The St. Mary’s Center (FY 08/09) site was
acquired to provide mental health, recovery,
and nutrition programs.
• Coalition for Language Access in Healthcare
(FY 09/10) assisted health care professionals
in providing culturally competent and
linguistically appropriate services.
• Hope Hospice Inc./Grief Support in the Tri-
Valley and Castro Valley (FY 09/10) served 400
adults, teens, and children, targeting the Tri-
Valley area and Castro Valley.
• HillCare Foundation(FY 09/10) offered case
management and gynecological medical
services for indigent and jail re-entry women,
focusing on East Oakland.
NOTE: Aids Alliance-Vital Life Services received a
$10,000 allocation but ceased operations on May
1, 2009. No information is provided on its use of
Measure A funds.
CONCERNS
Some of the Board allocations more closely matched the criteria of Measure A than others. Some allocations
are for direct services, while others are for informational, preventive, or long-term focused programs
and are therefore more difficult to quantify. The Measure A Committee recommends that the Board of
Supervisors work with the Health Care Services Agency to establish a matrix on how the allocations meet
the purpose of Measure A; this would help improve the Committee’s reporting ability. A component of the
matrix might be to indicate which allocations are multi-year commitments.
There is no process for soliciting or screening individual Board allocations. On the one hand, this allows for
creativity in exploring new approaches to delivering health care. This has apparently led to more allocations
oriented towards prevention and a more comprehensive approach to healthy living and disease and injury
prevention. This leads the Committee to question how providers that target those needs know to apply for
the discretionary Measure A funds.
The number of recipient contracts rose from 18 in FY 08/09 to 24 in FY 09/10—an increase of 30%.
While this can be viewed as broadening the reach of the funds, it also requires the use of additional Health
Care Services Agency administrative time.
The allocation of Measure A funds appeared to be more necessary to the viability of some programs than
others. In some cases, Measure A revenue was a small amount and a small percentage of the program
budget. The Measure A allocations are more meaningful when they are substantial enough either in dollars
or in percentage of the program budget to make a difference in whether services can be provided.
TIBURCIO VASqUEZ HEALTH CENTER
“Marco” came into the Health Center
requesting services and support to deal
with high levels of anxiety and stress. After
several meetings with a Health Educator, it
became clear that Marco needed greater
mental health services. The Health Educator
coordinated a meeting with Marco’s parent,
his academic counselor, and a mental health
therapist. The meeting helped address
some of the concerns shared by the team
and identified additional support services
in the community. Marco and his parent
were put in touch with the Willow Rock
Center, who conducted a more in-depth
assessment and connected Marco with
other resources.
Measure A Helps
47
ALLOCATION BY DISTRICT
District 1 – Supervisor Haggerty
Abode Services
Life Elder Care
Senior Support Program of Tri-Valley
Tri-Valley Community Foundation
Hope Hospice
Open Heart Kitchen
Safe Alternatives to Violent Environments
Tri-Valley Haven for Women
United Seniors of Oakland and Alameda
Chabot-Las Positas College
District 2 – Supervisor Steele
Center for Community Benefit (FY 08/09)
St. Rose Hospital Silva Pediatric Clinic
Tiburcio Vasquez Health Center
District 3 – Supervisor Lai-Bitker
Alameda Alliance
Alameda County Public Health-Dental
Asian Health Services-Banteay Srei
East Bay Asian Youth Center
Transform
Fruitvale Schools
District 4 – Supervisor Miley
Aids Alliance-Vital Life Services
Horizon-CommPre
Office of District 4 Re: Livability employees
Center for Community Benefit (FY 09/10)
Hillcare Foundation
Service Opportunity for Seniors
Mandela Marketplace
District 5 – Supervisor Carson
100 Black Men of the Bay Area, Inc.
Healthy Communities, Inc.
Combined Allocations from Supervisors
San Lorenzo School Health Services (District 3 and 4)
St Mary’s (District 3, 4, and 5)
Spectrum Community Services (District 2, 3, and 4)
Alameda Contra Costa Medical Association (District 2, 3, and 4)
HIV Education and Prevention Project of Alameda County (District 3, 4, and 5)
Healthy Communities, Inc. - Community of Hope Coalition (District 2 and 4)
BOARD OF SUPERVISORS’ MEASURE
A DISTRICT ALLOCATION FUNDING
OBJECTIVES FOR FY 08/09 AND FY 09/10
• Supervisor Scott Haggerty/District 1:
Allocations are directed specifically to
District 1 and generally to seniors and
agencies that can leverage funds.
• Supervisor Gail Steele/District 2:
Allocations are focused on children’s
services and on supporting direct service
programs. Attention is given to the
numbers of clients served and unmet
needs being addressed.
• Supervisor Alice Lai-Bitker/District 3:
Allocations attempt to fill small gaps
in addressing health disparities, with
attention given to immigrant and
language issues.
• Supervisor Nate Miley/District 4:
Emphasis is placed on public health and
prevention, especially in Ashland and
Cherryland; on African-American health
disparities in East Oakland; and on senior
issues.
• Supervisor Keith Carson/District 5: Has
generally approved larger grants with a
goal to leveraging matching funds, to
serve the needs of African-American boys
and men in Alameda County.
48
DISTRICT ALLOCATION AMOUNTS
DISTRICT
TOTAL FUNDS
AVAILABLE TO
ALLOCATE
FY 08/09
TOTAL
ALLOCATED
FY 08/09
YEAR-END
BALANCE
FY 08/09
TOTAL FUNDS
AVAILABLE TO
ALLOCATE
FY 09/10
TOTAL
ALLOCATED
FY 09/10
YEAR-END
BALANCE
FY 09/10
1 305,890 172,400 133,490 370,569 161,000 209,569
2 382,090 200,250 181,840 390,930 208,750 182,180
3 415,095 154,331 260,764 469,854 259,011 210,843
4 303,325 94,288 209,037 418,126 155,400 262,726
5 437,750 10,000 427,750 636,840 110,000 526,840
Total 1,844,150 631,269 1,212,881 2,286,319 894,161 1,392,158
49
APPENDIX A: Measure a revenue reCeived in eaCh fisCal year
APPENDIX B: fy 08/09 and fy 09/10 budgeT infOrMaTiOn
APPENDIX C: fy 08/09 and fy 09/10 Measure a fund disTribuTiOn by PrOvider Or PrOgraM
APPENDIX D: MaPs: geOgraPhiC disTribuTiOn Of PrOviders funded by Measure a in fy
08/09 and fy 09/10
Map 1 alameda County hospitals (County and Private) and Public health Programs
funded by Measure a in fy 08/09 and fy 09/10
Map 2 Physician reimbursement-emergency room locations
funded by Measure a in fy 08/09 and fy 09/10
Map 3 alameda County behavioral health Care services alcohol and drug Providers
funded by Measure a in fy 08/09 and fy 09/10
Map 4 alameda County behavioral health Care services Mental health Community–
based Organization Providers funded by Measure a in fy 08/09 and fy 09/10
Map 5 adolescent school-based health Centers
funded by Measure a in fy 08/09 and fy 09/10
Map 6 Primary Care Community–based Organizations
funded by Measure a in fy 08/09 and fy 09/10
aPPendiCes
50
51
APPENDIX A:
MEASURE A REVENUE RECEIVED IN EACH FISCAL YEAR
FISCAl yEAR 04/05
DATE REC’D
MONTH
EARNED
MEDICAL
CENTER COUNTY TOTAL
ACMC
CUMULATIVE
TOTAL
COUNTY
CUMULATIVE
TOTAL
TOTAL
CUMULATIVE
9/22/04 07/04 5,211,585 1,737,195 6,948,780 5,211,585 1,737,195 6,948,780
10/21/04 08/04 5,142,150 1,714,050 6,856,200 10,353,735 3,451,245 13,804,980
11/19/04 09/04 6,856,200 2,285,400 9,141,600 17,209,935 5,736,645 22,946,580
12/28/04 10/04 5,494,355 1,831,452 7,325,807 22,704,290 7,568,097 30,272,387
01/19/05 11/04 5,437,350 1,812,450 7,249,800 28,141,640 9,380,547 37,522,187
02/17/05 12/04 7,249,800 2,416,600 9,666,400 35,391,440 11,797,147 47,188,587
03/31/05 01/05 6,299,953 2,099,984 8,399,937 41,691,393 13,897,131 55,588,524
04/21/05 02/05 4,291,500 1,430,500 5,722,000 45,982,893 15,327,631 61,310,524
05/18/05 03/05 5,722,050 1,907,350 7,629,400 51,704,943 17,234,981 68,939,924
06/24/05 04/05 8,412,419 2,804,139 11,216,559 60,117,362 20,039,120 80,156,483
07/20/05 05/05 4,988,025 1,662,676 6,650,700 65,105,387 21,701,796 86,807,183
08/19/05 06/05 6,650,700 2,216,900 8,867,600 71,756,087 23,918,696 95,674,783
INTEREST EARNED 116,927 116,927
TOTAL 71,756,087 24,035,623 95,791,710
FISCAl yEAR 05/06
DATE REC’D
MONTH
EARNED
MEDICAL
CENTER COUNTY TOTAL
ACMC
CUMULATIVE
TOTAL
COUNTY
CUMULATIVE
TOTAL
TOTAL
CUMULATIVE
9/23/05 07/05 7,593,094 2,531,031 10,124,125 7,593,094 2,531,031 10,124,125
10/20/05 08/05 4,791,900 1,597,300 6,389,200 12,384,994 4,128,331 16,513,325
11/18/05 09/05 6,389,250 2,129,750 8,519,000 18,774,244 6,258,081 25,032,325
12/23/05 10/05 10,712,696 3,570,899 14,283,595 29,486,940 9,828,980 39,315,920
01/19/06 11/05 5,642,475 1,880,825 7,523,300 35,129,415 11,709,805 46,839,220
02/16/06 12/05 7,523,250 2,507,750 10,031,000 42,652,665 14,217,555 56,870,220
03/31/06 01/06 7,854,305 2,618,102 10,472,407 50,506,970 16,835,657 67,342,627
04/21/06 02/06 5,059,800 1,686,600 6,746,400 55,566,770 18,522,257 74,089,027
05/18/06 03/06 6,746,400 2,248,800 8,995,200 62,313,170 20,771,057 83,084,227
06/23/06 04/06 7,371,527 2,457,176 9,828,703 69,684,697 23,228,233 92,912,930
07/20/06 05/06 5,450,100 1,816,700 7,266,800 75,134,797 25,044,933 100,179,730
08/17/06 06/06 7,266,825 2,422,275 9,689,100 82,401,622 27,467,208 109,868,830
INTEREST EARNED 380,741 380,741
TOTAL 82,401,622 27,847,949 110,249,571
52
FISCAl yEAR 06/07
DATE REC’D
MONTH
EARNED
MEDICAL
CENTER COUNTY TOTAL
ACMC
CUMULATIVE
TOTAL
COUNTY
CUMULATIVE
TOTAL
TOTAL
CUMULATIVE
9/22/06 07/06 8,322,635 2,774,212 11,096,847 8,322,635 2,774,212 11,096,847
10/18/06 08/06 5,513,100 1,837,700 7,350,800 13,835,735 4,611,912 18,447,647
11/16/06 09/06 9,242,400 3,080,800 12,323,200 23,078,135 7,692,712 30,770,847
12/22/06 10/06 7,953,029 2,651,009 10,604,038 31,031,164 10,343,721 41,374,885
01/18/07 11/06 6,025,875 2,008,625 8,034,500 37,057,039 12,352,346 49,409,385
02/22/07 12/06 8,004,300 2,668,100 10,672,400 45,061,339 15,020,446 60,081,785
03/29/07 01/07 6,588,768 2,196,256 8,785,024 51,650,107 17,216,702 68,866,809
04/18/07 02/07 5,224,050 1,741,350 6,965,400 56,874,157 18,958,052 75,832,209
05/17/07 03/07 6,965,400 2,321,800 9,287,200 63,839,557 21,279,852 85,119,409
06/22/07 04/07 8,152,952 2,717,651 10,870,603 71,992,509 23,997,503 95,990,012
07/19/07 05/07 5,736,525 1,912,175 7,648,700 77,729,034 25,909,678 103,638,712
08/16/07 06/07 7,648,725 2,549,575 10,198,300 85,377,759 28,459,253 113,837,012
INTEREST EARNED 655,872 655,872
TOTAL 85,377,759 29,115,125 114,492,884
FISCAl yEAR 07/08
DATE REC’D
MONTH
EARNED
MEDICAL
CENTER COUNTY TOTAL
ACMC
CUMULATIVE
TOTAL
COUNTY
CUMULATIVE
TOTAL
TOTAL
CUMULATIVE
9/26/07 07/07 8,530,372 2,843,457 11,373,829 8,530,372 2,843,457 11,373,829
10/18/07 08/07 6,117,375 2,039,125 8,156,500 14,647,747 4,882,582 19,530,329
11/21/07 09/07 8,156,475 2,718,825 10,875,300 22,804,222 7,601,407 30,405,629
12/28/07 10/07 7,883,441 2,627,814 10,511,255 30,687,663 10,229,221 40,916,884
01/16/08 11/07 6,205,800 2,068,600 8,274,400 36,893,463 12,297,821 49,191,284
02/21/08 12/07 8,274,375 2,758,125 11,032,500 45,167,838 15,055,946 60,223,784
03/27/08 01/08 7,183,405 2,394,468 9,577,873 52,351,243 17,450,414 69,801,657
04/17/08 02/08 5,386,200 1,795,400 7,181,600 57,737,443 19,245,814 76,983,257
05/22/08 03/08 7,181,625 2,393,875 9,575,500 64,919,068 21,639,689 86,558,757
06/24/08 04/08 8,049,440 2,683,146 10,732,586 72,968,508 24,322,835 97,291,343
07/18/08 05/08 5,966,175 1,988,725 7,954,900 78,934,683 26,311,560 105,246,243
08/21/08 06/08 7,954,875 2,651,625 10,606,500 86,889,558 28,963,185 115,852,743
INTEREST EARNED 766,401 766,401
TOTAL 86,889,558 29,729,586 116,619,144
53
FISCAl yEAR 08/09
DATE REC’D
MONTH
EARNED
MEDICAL
CENTER COUNTY TOTAL
ACMC
CUMULATIVE
TOTAL
COUNTY
CUMULATIVE
TOTAL
TOTAL
CUMULATIVE
9/25/08 07/08 8,032,186 2,677,396 10,709,582 8,032,186 2,677,396 10,709,582
10/15/08 08/08 6,121,050 2,040,350 8,161,400 14,153,236 4,717,746 18,870,982
11/20/08 09/08 8,161,425 2,720,475 10,881,900 22,314,661 7,438,221 29,752,882
12/26/08 10/08 6,854,632 2,284,877 9,139,509 29,169,293 9,723,098 38,892,391
01/22/09 11/08 6,073,950 2,024,650 8,098,600 35,243,243 11,747,748 46,990,991
02/19/09 12/08 6,661,050 2,220,350 8,881,400 41,904,293 13,968,098 55,872,391
03/27/09 01/09 6,506,559 2,168,853 8,675,412 48,410,852 16,136,951 64,547,803
04/16/09 02/09 5,227,725 1,742,575 6,970,300 53,638,577 17,879,526 71,518,103
05/21/09 03/09 5,471,475 1,823,825 7,295,300 59,110,052 19,703,351 78,813,403
06/23/09 04/09 5,786,013 1,921,503 7,707,516 64,896,065 21,624,854 86,520,919
07/16/09 05/09 5,148,450 1,716,150 6,864,600 70,044,515 23,341,004 93,385,519
08/20/09 06/09 5,906,775 1,968,925 7,875,700 75,951,290 25,309,929 101,261,219
INTEREST EARNED 363,681 363,681
TOTAL 75,951,290 25,673,610 101,624,900
FISCAl yEAR 09/10
DATE REC’D
MONTH
EARNED
MEDICAL
CENTER COUNTY TOTAL
ACMC
CUMULATIVE
TOTAL
COUNTY
CUMULATIVE
TOTAL
TOTAL
CUMULATIVE
9/29/09 07/09 6,149,831 2,049,944 8,199,775 6,149,831 2,049,944 8,199,775
10/22/09 08/09 5,255,175 1,751,725 7,006,900 11,405,006 3,801,669 15,206,675
11/12/09 09/09 5,621,400 1,873,800 7,495,200 17,026,406 5,675,469 22,701,875
12/17/09 10/09 6,841,664 2,280,555 9,122,219 23,868,070 7,956,024 31,824,094
01/14/10 11/09 5,547,675 1,849,225 7,396,900 29,415,745 9,805,249 39,220,994
02/18/10 12/09 7,083,300 2,361,100 9,444,400 36,499,045 12,166,349 48,665,394
03/22/10 01/10 5,300,019 1,766,673 7,066,692 41,799,064 13,933,022 55,732,086
04/16/10 02/10 4,565,100 1,521,700 6,086,800 46,364,164 15,454,722 61,818,886
05/19/10 03/10 6,271,650 2,090,550 8,362,200 52,635,814 17,545,272 70,181,086
06/17/10 04/10 6,715,126 2,238,375 8,953,502 59,350,940 19,783,647 79,134,587
07/06/10 05/10 4,990,200 1,663,400 6,653,600 64,341,140 21,447,047 85,788,187
08/19/10 06/10 6,246,750 2,082,250 8,329,000 70,587,890 23,529,297 94,117,187
INTEREST EARNED 89,426 89,426
TOTAL 70,587,890 23,618,724 94,206,613
54
FISCAl yEAR 10/11
DATE REC’D
MONTH
EARNED
MEDICAL
CENTER COUNTY TOTAL
ACMC
CUMULATIVE
TOTAL
COUNTY
CUMULATIVE
TOTAL
TOTAL
CUMULATIVE
9/06/10 07/10 7,621,466 2,540,489 10,161,954 7,621,466 2,540,489 10,161,954
10/5/10 08/10 5,148,675 1,716,225 6,864,900 14,486,366 4,256,714 17,026,854
11/19/10 09/10 6,414,900 2,138,300 8,553,200 23,039,566 6,395,014 25,580,054
12/16/10 10/10 7,979,212 2,659,737 10,638,949 33,678,514 9,054,751 36,219,003
01/5/10 11/10 5,770,575 1,923,525 7,694,100 41,372,614 10,978,276 43,913,103
02//10 12/10
03//10 01/11
04//10 02/11
05//10 03/11
06//10 04/11
07//10 05/11
08//10 06/11
INTEREST EARNED 11,945
TOTAL 32,934,827 10,990,220 43,913,103
55
APP
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.
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.
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a
t
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n
.
56
APP
E
N
D
I
X
B
:
F
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9
/
1
0
B
UD
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NF
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APPENDIX C:
FY 08/09 AND FY 09/10 MEASURE A FUND DISTRIBUTION
BY PROVIDER OR PROGRAM
MEASURE A
ALLOCATION
FY 08/09
EXPENDED
FY 08/09
MEASURE A
ALLOCATION
FY 09/10
EXPENDED
FY 09/10
GROUP 1: BEHAVIORAL HEALTH
Alameda County Behavioral Health Care Services Community-Based Organization Providers
Alcohol and Drug Providers
Alameda Family Services 13,833 13,463 14,248 -
Asian Community Mental Health Services 4,040 - 4,161 462
Asian Pacific Psychological Services 5,070 4,942 - -
Axis Community Health, Inc. 24,820 13,738 25,565 9,521
Baart Behavioral Health Services, Inc. 966 966 1,279 -
Berkeley Addiction Treatment Services, Inc. 5,613 5,613 5,781 5,781
Bi-Bett Corporation 38,787 36,321 39,951 5,493
Building Opportunities for Self-Sufficiency 2,133 2,133 2,197 2,197
Carnales Unidos Reformando Adictos 21,832 21,832 22,487 22,487
Community Drug Council 25,564 25,564 26,331 26,331
Community Health for Asian Americans --5,222 3,549
Davis Street Community Center, Inc. 10,753 10,753 11,076 11,076
East Bay Asian Youth Center 2,995 2,995 3,085 3,085
East Bay Community Recovery Project 35,401 35,401 36,463 36,463
Filipinos for Affirmative Action, Inc. 2,245 2,245 2,312 2,312
Health & Human Resources Education Center 5,010 5,009 5,160 5,160
HIV Education and Prevention Project of Alameda Co. - - - -
Horizon Services, Inc. 109,329 109,329 112,609 63,483
Humanistic Alternatives to Addiction 3,085 3,085 3,178 2,964
Latino Commission on Alcohol and Drug 60,132 60,132 61,936 57,476
Magnolia Women’s Recovery Program 5,036 - 5,187 5,187
Native American Health Center 3,848 3,732 3,963 2,261
New Bridge Foundation, Inc. 44,993 42,064 46,343 46,343
Options Recovery Services 21,130 21,764 -
Second Chance, Inc. 72,090 72,090 74,253 74,253
Senior Support of the Tri-Valley 2,156 2,107 2,221 2,221
Sexual Minority Alliance of Alameda County 2,536 - 2,612 -
Solid Foundation, Inc. 56,067 24,075 57,749 9,459
St. Mary’s Center 3,893 3,893 4,010 4,010
Thunder Road-Adolescent Treatment 12,278 12,278 12,646 12,646
West Oakland Health Council, Inc. 44,848 44,848 46,193 46,193
Young Men’s Christian Association 9,436 9,436 9,719 9,315
ZDK Inc. 276 250 --
TOTAL 650,195 568,295 669,701 469,729
58
MEASURE A
ALLOCATION
FY 08/09
EXPENDED
FY 08/09
MEASURE A
ALLOCATION
FY 09/10
EXPENDED
FY 09/10
GROUP 1: BEHAVIORAL HEALTH (CONTINUED)
Alameda County Behavioral Health Care Services Community-Based Organization Providers (continued)
Mental Health Providers
Alameda County Mental Health Association 46,936 41,073 48,344 48,344
Alameda County Network of Mental Health 33,470 33,470 34,475 34,475
Alameda Family Services 11,177 - 11,513 7,474
Ann Martin Children’s Center 20,848 - 21,473 21,473
Asian Community Mental Health Services 64,516 52,780 66,451 44,885
Bay Area Community Services, Inc. 108,070 108,070 111,312 -
Berkeley Place, Inc. 29,641 26,941 30,530 30,530
Bonita House, Inc. 72,200 72,200 74,366 69,166
Building Opportunities for Self-Sufficiency 66,413 66,413 68,405 68,405
Center for Independent Living 2,293 2,293 2,362 2,362
Crisis Support Services of Alameda County 30,957 30,957 31,886 31,886
East Bay Agency for Children 66,003 52,780 67,983 67,983
East Bay Community Recovery Project 16,618 16,618 10,929 -
Family Paths, Inc. 26,271 26,271 27,060 27,060
La Cheim School, Inc. 31,566 552 32,513 -
La Clinica De La Raza, Inc. 79,977 - 82,376 -
Lincoln Child Center 24,601 24,601 25,339 25,339
Native American Health Center 3,020 3,020 3,111 3,111
Regents of the University of California 7,770 7,770 8,003 -
Sabacute Treatment for Adolescent 15,160 15,160 15,615 13,300
Seneca Residential & Day Treatment Center 62,653 - 64,532 -
Southern Alameda County Comite for Raza 62,440 28,674 64,313 64,313
Telecare Corporation 1,069,515 - 1,101,612 -
Travelers Aid Society of Alameda County, Inc. 10,477 10,477 --
West Oakland Health Council, Inc. 73,315 - 75,515 75,515
SRP Contracts 43,398 43,398 46,251 -
Reserve -- 15,415 -
TOTAL 2,079,305 663,518 2,141,684 635,621
Alameda County Behavioral Health Care Services
Detoxification/Sobering Station
2,121,800 1,946,684 2,121,800 2,121,800
Mental Health Costs for Juvenile Justice Center 530,450 530,450 530,450 530,450
Mental Health Costs for Glen Dyer Jail In Oakland 795,675 795,675 795,675 795,675
Criminal Justice Screening/In-Custody Services
at Santa Rita Jail
3,816,664 3,816,664 3,816,664 3,816,664
59
MEASURE A
ALLOCATION
FY 08/09
EXPENDED/
ENCUMBERED
FY 08/09
MEASURE A
ALLOCATION
FY 09/10
EXPENDED/
ENCUMBERED
FY 09/10
GROUP 2: HOSPITAL, TERTIARY CARE, OTHER
Administration/Infrastructure Support 212,180 185,273 212,180 120,074
Children’s Hospital 2,387,025 2,387,025 2,387,025 2,387,025
St. Rose Hospital 2,387,025 2,387,025 2,387,025 2,387,025
Measure A Funds Used to Partially Offset Base Funding
Erosion in Health and Mental Health Realignment
Revenues
2,645,320 2,645,320 --
MEASURE A
ALLOCATION
FY 08/09
EXPENDED/
ENCUMBERED
FY 08/09
MEASURE A
ALLOCATION
FY 09/10
EXPENDED/
ENCUMBERED
FY 09/10
GROUP 3: PUBLIC HEALTH
Public Health Prevention Initiative
Chronic Disease and Injury Prevention
Project. New Start 16,917 16,917 17,595 17,595
Comm. Designed Initiative 125,000 125,000 130,013 130,013
Asthma 211,543 211,543 220,024 211,251
Diabetes 265,427 265,427 278,035 278,035
Healthy Kids Healthy Teeth 149,267 149,267 153,115 143,986
EMS 187,244 126,476 160,916 160,916
Health Inequities and Community Capacity-Building
Comm. Designed Initiative 50,000 50,000 52,005 52,005
Office of Dir. / CAPE 720,569 720,569 655,854 655,854
Community Nursing 98,509 98,509 102,458 102,458
Immunization Registry 197,263 197,263 205,172 205,172
HIV Prevention 92,800 92,800 96,522 96,522
FHS Healthy Passage System of Care 98,465 98,465 102,414 102,414
Obesity Prevention and School Health
Nutrition Services 397,306 397,306 413,237 413,237
PH Nursing 177,390 175,522 184,503 184,503
Comm. Designed Initiative 395,000 395,000 410,839 410,839
TOTAL 3,182,700 3,120,064 3,182,702 3,164,800
MEASURE A
ALLOCATION
FY 08/09
NUMBER OF
CLAIMS PAID
FY 08/09
MEASURE A
ALLOCATION
FY 09/10
EXPENDED/
ENCUMBERED
FY 09/10
ER and On-Call Physician Reimbursement
Berkeley Emergency Medical Group 505,327 7,219 495,318 6,527
California Emergency Physicians 426,216 6,014 409,511 4,925
60
MEASURE A
ALLOCATION
FY 08/09
NUMBER OF
CLAIMS PAID
FY 08/09
MEASURE A
ALLOCATION
FY 09/10
EXPENDED/
ENCUMBERED
FY 09/10
City of Alameda Health Care ––27,183 103
Eden Emergency Medical Group 30,992 376 46,801 591
Northern California Trauma Medical Group 62,833 268 30,711 161
Phoenix Emergency Physicians 158,911 2,433 148,549 2,296
Pleasanton Emergency Medical Group 36,100 506 75,617 1,006
R. Scott Snyder MD Inc. 31,559 80 ––
Raveendra Nadaraja MD 32,858 39 31,563 29
TOTAL FOR ABOVE PROVIDERS RECEIVING
OVER $20,000
1,284,796 16,935 1,265,253 15,638
TOTAL FOR 34 PROVIDERS RECEIVING
UNDER $20,000
124,504 432 144,661 392
TOTAL 1,409,300 17,367 1,409,914 16,030
MEASURE A
ALLOCATION
FY 08/09
EXPENDED/
ENCUMBERED
FY 08/09
MEASURE A
ALLOCATION
FY 09/10
EXPENDED/
ENCUMBERED
FY 09/10
GROUP 4: PRIMARY CARE
Primary Care Community-Based Organizations
AHS 962,277 962,277 962,277 962,277
Axis 551,876 551,876 551,876 551,876
BACQHC 333,306 138,877 --
Healthy Oakland --466,352 466,352
La Clinica 1,357,431 1,357,431 1,357,431 1,357,431
LifeLong 934,875 934,875 934,875 934,875
NAHC 424,213 424,213 424,213 424,213
Tiburcio 685,827 685,827 685,827 685,827
Tri-City 811,643 811,643 811,643 811,643
West Oakland 650,390 650,390 650,390 650,390
Day Labor 159,569 308,129 159,135 232,073
TOTAL 6,871,407 6,825,538 7,004,019 7,076,957
School Health Services Coalition (Formerly School-Based Health Centers)
Alameda Family Services (Alameda and Encinal High) 137,917 137,917 137,917 137,917
Children’s Hospital and Research Center Oakland
(McClymonds High and Youth Uprising)
137,917 137,917 137,917 137,917
City of Berkeley (Berkeley High)68,958 68,958 68,958 68,958
East Bay Agency for Children (Oakland High) 52,184 52,184 52,184 52,184
Health Care Services Agency (Ashland Youth Center)--47,060 47,060
Tiburcio Vasquez (Logan and Tennyson High) 137,917 137,917 137,917 137,917
La Clinica (Roosevelt, Tech, Tiger, and San Lorenzo)275,834 275,834 275,834 275,834
Evaluation and Administration 250,173 228,224 250,173 241,505
TOTAL 1,060,900 1,038,951 1,060,900 1,052,232
61
MEASURE A
ALLOCATION
FY 08/09
EXPENDED/
ENCUMBERED
FY 08/09
MEASURE A
ALLOCATION
FY 09/10
EXPENDED/
ENCUMBERED
FY 09/10
Medical Costs for Juvenile Justice Center 265,225 181,881 265,225 145,410
Healthy Communities, Inc.132,613 132,613 --
NOTE: In FY 09/10, Healthy Communities, Inc. became part of the Primary Care Community-Based Organizations. See “Primary Care
Community-Based Organizations” for details.
Preventive Care Pathways 132,613 132,613 132,613 132,482
Other Capital (Alameda Hospital)0 100,000 --
2007 Capital Investment in the County’s
Health Care Safety Net
0 $993,438 0 $262,854
MEASURE A
ALLOCATION
FY 08/09
EXPENDED/
ENCUMBERED
FY 08/09
MEASURE A
ALLOCATION
FY 09/10
EXPENDED/
ENCUMBERED
FY 09/10
GROUP 5: BOARD OF SUPERVISORS
Board of Supervisors Discretionary Allocations 1,045,450 455,974 1,045,450 897,606
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AlAmedA County beHAviorAl HeAltH CAre serviCes
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Map 6
primAry CAre Community–bAsed orgAniZAtions
Funded by meAsure A in Fy 08/09 And Fy 09/10
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