HomeMy WebLinkAboutmeasurea-rpt-05-07-webREVIEW OF EXPENDITURES IN
Fiscal Year (FY) 2005/2006 July 1, 2005 – June 30, 2006
and FY 2006/2007 July 1, 2006 – June 30, 2007
MEASURE A
Essential Health Care Services
Tax Ordinance
FY 2005/2006 & FY 2006/2007
OVERSIGHT COMMITTEE
2ND REPORT
TO THE ALAMEDA COUNTY
BOARD OF SUPERVISORS
AND THE PUBLIC
MEASURE A
Essential Health Care Services Tax Ordinance
OVERSIGHT COMMITTEE
2ND REPORT
TO THE ALAMEDA COUNTY BOARD OF SUPERVISORS
AND THE PUBLIC
REVIEW OF EXPENDITURES IN
Fiscal Year (FY) 2005/2006
July 1, 2005 – June 30, 2006
and
FY 2006/2007
July 1, 2006 – June 30, 2007
TABLE OF CONTENTS
MEASURE A OVERSIGHT COMMITTEE MEMBERS ..................................................................................... 1
EXECUTIVE SUMMARY ........................................................................................................................ 3
SECTION 1: STATE OF HEALTH CARE FUNDING ..................................................................................... 7
SECTION 2: FUNDING ALLOCATION AND REVIEW PROCESS ...................................................................... 9
SECTION 3: HOW THE MONEY WAS SPENT ....................................................................................... 11
Review of Fiscal Year (FY) 05/06 and 06/07 Expenditures: Alameda County Medical Center .......... 12
Review of Fiscal Year (FY) 05/06 and 06/07 Expenditures: 25% Measure A Funds Allocated
by the Alameda County Board of Supervisors .................................................................................... 14
FY 05/06 Reduction Target Allocations .............................................................................................. 16
Medicare Part D Supplement ............................................................................................................. 14
Capital Request for Proposal (RFP) ..................................................................................................... 18
Other Capital Projects ......................................................................................................................... 20
Alameda County Public Health Department: Prevention Initiative ..................................................... 21
Emergency Room (ER) and On-Call Physician Compensation ........................................................... 22
Medical Costs for Juvenile Justice Center Under Administration/Indigent Health ............................. 23
Administration/Infrastructure Support ............................................................................................... 24
Alameda County Behavioral Health Care Services Community-Based Organization Providers ........... 24
Alameda County Behavioral Health Care Services Detox/Sobering Station ........................................ 25
Mental Health Costs for Juvenile Justice Center ................................................................................. 27
Mental Health Costs for Oakland and Glen Dyer Jail ......................................................................... 27
Criminal Justice Screening/In-Custody Services ................................................................................ 28
Board of Supervisors Discretionary Allocations .................................................................................. 28
Non-County Hospitals ........................................................................................................................ 30
School-Based/Linked Health Centers ................................................................................................. 32
Primary Care Community-Based Organizations ................................................................................. 34
CONCERNS .................................................................................................................................... 39
APPENDICES.................................................................................................................................... 41
Appendix A:Measure A Revenue Received in FY 05/06 and FY 06/07 ............................................. 43
Appendix B:FY 05/06 and FY 06/07 Measure A Fund Distribution by Provider or Program........... 45
Appendix C: Measure A Service Provider Program Descriptions ......................................................... 49
Appendix D:Geographic Distribution of Providers Receiving Measure A Funds
County,Private, and Nonprofit Hospitals and Alameda County Public Health Program............ Map 1
Capital RFP Fund Recipients...................................................................................................... Map 2
Emergency Rooms Where ER and On-Call Physicians Provided Service.................................... Map 3
Alameda County Behavioral Health Care Services Alcohol and Drug Providers......................... Map 4
Alameda County Behavioral Health Care Services Mental Health CBO Providers ...................... Map 5
Adolescent School-Based Health Centers ...................................................................................Map 6
Primary Care Community Based Organization (CBO) Clinics................................................... Map 7
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MEASURE A OVERSIGHT COMMITTEE MEMBERS
COMMITTEE MEMBER REPRESENTING/NOMINATED BY
Rich Ambrose City Managers’ Association
Adele Amodeo* Supervisorial District 5
Ken Ballard, Pharm. D. League of Women Voters
Louis Chicoine Supervisorial District 1
Bradley Cleveland Central Labor Council of Alameda County
Kay Eisenhower Supervisorial District 4
Jay Garfinkle, M.D. Alameda Contra Costa Medical Association
Arthur Geen Alameda County Taxpayers Association
Phil Hayes*Central Labor Council of Alameda County
Peter Manoleas, LCSW* City of Berkeley
Neil Marks Hospital Council of Northern California
Larry J. Platt, M.D. Alameda County Public Health Commission
Beth Pollard City Managers’ Association
Don Sheppard Supervisorial District 2
Ron Silva* Supervisorial District 3
Ronald Tauber Alameda County Mental Health Board
Sal Tedesco League of Women Voters
*Resigned from the Oversight Committee during production of this report.
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T HIS IS THE SECOND report of the Measure A Oversight Committee. It reviews the expenditure of
Measure A sales tax revenue for fiscal years 2005/2006 and 2006/2007 (FY 05/06 and FY 06/07).
The Committee’s concerns are highlighted below and are discussed in greater detail in the body
of the report.
This report is based on a number of sources:
• self-reported information provided by recipients of Measure A funds
• presentations by the Alameda County Medical Center (ACMC), the county Public Health Department,
Bay Area Consortium for Quality Health Care (BACQHC), and some members of the Board of
Supervisors (BOS)
•the county Health Care Services Agency (HCSA), which monitors the contracts with recipients of
Measure A funds—including negotiating scope of work and payment schedule, developing actual
contracts,preparing Board letters for approval, authorizing payments, and tracking expenditures.
Measure A, the Essential Health Care Services Initiative, was adopted by Alameda County voters in March
2004.Measure A 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.
The initiative generated $109,868,830 in FY 05/06 and $113,837,012 in FY 06/07.The ACMC received
75% of these funds, and the BOS distributed the remainder of the funds to other health care providers,
including:
• initiatives funded by the Alameda County Public Health and Behavioral Health Care Departments
• emergency room physicians
•primary care clinics
•Children’s and St. Rose Hospitals
• school-based health centers.
MAJOR CONCLUSION
The Oversight Committee found the ACMC and most other recipients of sales tax revenue spent the funds
in compliance with the strictures of Measure A.
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
EXECUTIVE SUMMARY
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data, 11% of County residents, about 160,000 people, are uninsured, and another 21% are eligible for
public health insurance programs, including Medi-Cal and Healthy Families, that target low income
individuals and families.
In addition to continuing existing programs, during the two years under review, the sales tax revenue
allowed a number of health care providers to expand services and plan for future growth:
• Measure A funds provided for 42,430 new visits for the uninsured to community-based organization
(CBO) primary care clinics.
• The County’s 11 school-based health centers received state and federal matching funds, which allowed
them to substantially increase the number of medical and mental health visits.
• The eight community health centers associated with the Alameda Health Consortium received private
and public matching funds to address health disparities through the expansion of primary care and
chronic disease management services.
• Children’s Hospital received federal matching funds to expand pediatric services.
• St. Rose Hospital received federal matching funds to sustain operations at their existing level.
• The Public Health Department enhanced its educational and outreach programs targeting chronic
diseases, such as asthma and diabetes.
• Tri-City Homeless Coalition purchased a new mobile health clinic, and Axis Community Clinic
expanded its Livermore clinic.
• Nineteen community-based programs, from Bonita House in Oakland to Tiburcio Vasquez Health
Center in Union City, purchased needed equipment or renovated existing facilities to allow for
increases in patient loads.
• Seventy-five percent of the total Measure A funds were used by ACMC to increase staff productivity,
enhance its maternal and child health programs, and institute both a short- and a long-term planning
process.
•Measure A funds allocated for the Medicare Part D prescription drug subsidy program were critical in
preventing significant problems facing the County’s dual eligible population.
CONCERNS
In developing this report, the Oversight Committee has identified several concerns regarding the state of
health care funding in general, 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. In addition, the
Committee raised concerns regarding Measure A funding specifically, including the following:
• A decline in outpatient clinic visits at ACMC, with no justifiable explanation provided.
• The lack of a requirement that capital fund recipients provide services to low-income, underinsured, or
indigent patients for a specified period of time.
•The lack of a specified process for announcing or requesting a BOS discretionary allocation, as well as
the lack of parameters to streamline or set limits on the allocation process—resulting in greater
Measure A staff time and funding spent on administration of piecemeal, often small, allocations.
•Carryover of unspent funds from BOS discretionary allocations is not required to address a specific
funding goal.
• Concerns cited in our last report (of FY 04/05 expenditures) regarding BACQHC have continued in
the two fiscal years covered in this report. BACQHC submitted reports that did not contain information
necessary to verify compliance with Measure A (and, in fact, included information indicating that the
expenditure of funds did not fall within compliance with Measure A) and were inconsistent with the
reporting compliance guidelines.
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• The Oversight Committee is concerned that it does not have adequate information to ensure the BOS
that replacement or substitution of County funds (also called supplantation) with Measure A funds is
not occurring.
• 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.
CITIZEN OVERSIGHT COMMITTEE
One of the provisions of Measure A was the requirement to establish a Citizen Oversight Committee.The
role of the Oversight Committee is to annually review Measure A expenditures for each fiscal year and
report to the BOS on the conformity of such expenditures to the purposes set forth in the Measure.
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 Oversight
Committee, please contact Jennifer Chan at (510) 618-2016 or jennifer.chan@acgov.org.
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SECTION 1
STATE OF HEALTH CARE FUNDING
A LAMEDA COUNTY’S MEASURE A was passed by 71% of the voters in March 2004, in response to a
statewide crisis in health care. Publicly supported services in primary care, hospital care, public
health, and behavioral health faced sharply increasing costs with inadequate resources. Measure A
funds substantially eased this crisis and stabilized Alameda County Medical Center (ACMC) in fiscal years
2004-2007 (FYs 04-07); however, the current economic downturn threatens some of the gains achieved.
Alameda County will be impacted in several ways by this downturn. First, sales tax receipts are growing at
a slower rate each year, meaning that Measure A funding increases grow more slowly also. Between FY
04/05 and FY 05/06, total Measure A revenues increased by approximately 15%; between FY 05/06 and
FY 06/07,the rate of increase was only four percent. Projecting ahead based on the first nine months of
FY 07/08,the rate of increase between FY 06/07 and FY 07/08 will be less than two percent. Second,
trends in federal and state funding show cuts in health care spending, creating concern over the impacts
such cuts may have in Alameda County. Third, the number of uninsured county residents is growing—
from 127,000 in 2001 to 166,000 in 2005—as employers dilute or drop health insurance coverage for
their workers. As noted by the California Association of Public Hospitals and Health Systems, “though just
6 percent of all hospitals in the state,public hospitals provide nearly half of the hospital care provided to
uninsured patients” (footnote #1, “Policy Issues for Public Hospitals Under Health Care Reform
Legislation,” April 20, 2007). As the number of uninsured and underinsured patients grows, Alameda
County’s public medical institutions will shoulder most of the strain.
One bright spot in this downturn is the passage of Proposition 63, an additional income tax for people
who make over $1 million annually. Proposition 63 proceeds went to the Mental Health Services Act to
provide mental health services.These proceeds generated substantial revenue for the Alameda County
Health Care Services Agency (HCSA). In FY 05/06, HCSA received $11,035,300 in planning money. In FY
06/07, HCSA received $11,145,798 in Prop 63 funding.
Recent and proposed 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.
Despite the discouraging projections about state and federal funding, as well as the decreasing rate of
growth in Alameda County sales tax revenue, Measure A has had many positive effects in the two fiscal
years covered by this report. In addition to stabilizing ACMC’s budget and administrative structure, it has
permitted serious long-term planning to meet future health care needs for county residents.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.
Measure A’s half-cent sales tax increase generated $109,868,830 in fiscal year 05/06, and $113,837,012
in fiscal year 06/07.
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SECTION 2
FUNDING ALLOCATION AND REVIEW PROCESS
Measure A funds are allocated as follows:
• 75% of funds are designated directly to the Alameda County Medical Center (ACMC).
• The remaining 25% are allocated by the Alameda County Board of Supervisors (BOS).
On December 14, 2004, the BOS approved three-year funding allocations of its 25% share of Measure A
funds in eight general categories:
•Alameda County Public Health Prevention Initiative
• Emergency Room and On-Call Physician Compensation
• Alameda County Behavioral Health Care Community-Based Organization Providers
• Alameda County Detoxification/Sober Station
•Community-Based Organization Primary Care Clinics
• Private and District Hospitals
• School-Based Health Centers
•Health Insurance Expansion and Board of Supervisors Discretionary Allocation.
When the three-year funding allocations expired in June 2007, the BOS agreed on the importance of
maintaining most of the existing allocations in order to sustain a level of care to the County’s residents.
The funding allocations in the eight categories generally remained the same and were approved for
another three-year allocation through June 2010. For fiscal year 07/08, the BOS approved a 3% cost
of living increase adjustment (COLA) on the approved allocations.
While reviewing these funding allocations through June 2007, the Measure A Oversight Committee
decided to review expenditures in both FY 05/06 and FY 06/07 and provide information on its findings
in one report.The Committee developed a report form, containing questions on specific uses of funds
received, for all Measure A fund recipients to complete.The Committee also heard presentations on selected
programs including,among others,Medicare Part D; the 2005 capital request for proposals; other capital
allocations’ administration/infrastructure support; allocation for reduction targets under administration/
indigent health, public health, and behavioral health care; the BOS allocations; the Bay Area Consortium for
Quality Health Care; and the ACMC.The Committee used the report forms returned by most Measure A
fund recipients, along with the presentations where applicable, to review all funding allocations.The
Committee’s findings are discussed in detail in the following sections.
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SECTION 3
HOW THE MONEY WAS SPENT
S EVENTY-FIVE PERCENT of funds generated by Measure A are specifically designated for the Alameda
County Medical Center (ACMC) and are allocated by the ACMC Board of Trustees.The remaining 25%
of funds are allocated by the Alameda County Board of Supervisors (BOS) and are managed by the
Alameda County Health Services Agency (HCSA).
Measure A generated $109,868,830 in FY 05/06 (not including interest earned), and $113,837,012 in FY
06/07 (not including interest earned).The funds were allocated as follows:
FY05/06 FY06/07
Funds Specifically Designated for ACMC (75%)$82,401,622 $85,377,759
Funds Allocated by the Board of Supervisors (25%) $27,467,208 $28,549,253
TOTAL $109,868,830 $113,837,012
In FY 05/06,the Alameda County budget totaled $2,184,041,363.The Alameda County Health Care
Services Agency (HCSA) budget totaled $469,743,300, or 21.5% of the total County budget. Measure A
funds not specifically designated for ACMC accounted for 5.8% of the HCSA budget.
In FY 06/07, the Alameda County budget totaled $2,187,313,176.The Alameda County HCSA budget
totaled $492,605,431, or 22.5% of the total County budget. Measure A funds not specifically designated
for ACMC accounted for 5.8% of the HCSA budget.
The following sections provide more detail on the allocation and expenditure of Measure A funds.
Figure 1
DISTRIBUTION OF MEASURE A FUNDS
Alameda County Board of Supervisors
Alameda County Medical Center Board of Trustees
25%
75%
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REVIEW OF FY 05/06 AND FY 06/07 EXPENDITURES:
ALAMEDA COUNTY MEDICAL CENTER
FY 05/06 Allocation:$82,401,622
Amount Expended/Encumbered:$82,401,622
FY 06/07 Allocation:$85,377,759
Amount Expended/Encumbered:$85,377,759
The Alameda County Medical Center (ACMC)
received a total of $82,401,622 in Measure A
revenue in FY 05/06, and a total of $85,377,759 in
FY 06/07.For FY 05/06,Measure A revenue
represented approximately 21% of ACMC’s total
annual revenue of approximately $392 million. For
FY 06/07,Measure A revenue represented
approximately 20% of ACMC’s total annual revenue
of approximately $421 million.
Medi-Cal, Medicare, and Alameda County reimburse
ACMC at a rate that is below its actual costs. Measure
A revenue fills this “funding gap.” ACMC faces the
ongoing problem of sporadic, uneven state and
federal reimbursements at the same time that future
sales tax revenues may decline, reducing ACMC’s
ability to cope with escalating health care costs.
Thanks in part to Measure A funding, ACMC was able
to fulfill its mission as one of the county’s primary
health safety net providers and continues to offer a
full continuum of care to the county’s indigent and
low income residents. ACMC accounts for over half of
all indigent,uncompensated, and charity care
provided in the county.
21%
79%
20%
80%
Figure 2
ALAMEDA COUNTY MEDICAL CENTER TOTAL ANNUAL REVENUE
FY 05/06 FY 06/07
ACMC HIGHLIGHTS FOR
FY 05/6 AND FY 06/07
n stabilization of ACMC’s financial condition
n stabilization of executive leadership
n increased overall staffing efficiency and
reduction in costs per hospital bed
n reduction in number of emergency room
patients not treated after triage
n improvements in medical interpretation
program
n labor and delivery program enhancements
n enhancement of early pediatric care pro-
gram addressing income disparities in
child dental health
n receipt of three major quality recognition
awards
Measure A Revenue
Non Measure A Revenue
Measure A Revenue
Non Measure A Revenue
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ACMC 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. A fourth clinic at Juvenile Hall was funded through April 2007.
Outpatient clinic visits declined in FY 06/07 as compared to FY 05/06 despite increased overall funding,
which is only partially explained by the closure of the Juvenile Hall clinic.Total visits in FY 06/07 were
252,234, compared to 268,692 visits in FY 05/06—a reduction of 16,458 clinic visits.The loss of the
Juvenile Hall clinic accounts for 6,313 fewer visits in FY 06/07, meaning that the other clinics saw a
reduction of more than 10,000 visits, representing a drop of four percent. ACMC was unable to provide a
full explanation for the decrease.The unexplained decline as well as the inability to account for it are both
of concern to the Oversight Committee.
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REVIEW OF FY 05/06 AND FY 06/07 EXPENDITURES:
25% MEASURE A FUNDS ALLOCATED BY THE
ALAMEDA COUNTY BOARD OF SUPERVISORS
FY 05/06 BUDGET INFORMATION
In FY 05/06, the 25% of Measure A revenue allocated by the Board of Supervisors (BOS) was budgeted at
approximately $28.5 million and was allocated as follows:
Carryover Expended Carryover
FY 05/06 from Total and/or to
Department Allocation Previous FY* Allocation Encumbered Next FY* Total Savings**
Public Health (Total: 5,542,659)
Pubic Health Prevention Initiative 3,000,000 0 3,000,000 2,767,660 0 2,767,660 232,340
ER Physician Reimbursement 1,500,000 150,000 1,650,000 1,499,095 150,000 1,649,095 905
05/06 Reduction Target 1,042,659 0 1,042,659 142,668 0 142,668 899,991
Behavioral Health (Total: 6,618,053)
CBO Providers 2,250,000 0 2,250,000 2,250,000 0 2,250,000 0
Detox/Sober Station 2,000,000 2,000,000 4,000,000 270,000 3,730,000 4,000,000 0
FY 05/06 Reduction Target 2,268,053 0 2,268,053 2,268,053 0 2,268,053 0
Medicare Part D 100,000 0 100,000 37,334 62,666 100,000 0
Admin/Indigent Health (Total: 15,863,820)
County Primary Care CBOs 5,000,000 0 5,000,000 5,000,000 0 5,000,000 0
Non-County Hospitals 4,500,000 0 4,500,000 4,500,000 0 4,500,000 0
School-Based Health Centers 1,000,000 210,000 1,210,000 988,061 210,000 1,198,061 11,939
Insurance Expansion 250,000 0 250,000 0 0 0 250,000
FY 05/06 Reduction Target 2,063,820 0 2,063,820 2,063,820 0 2,063,820 0
Capital Request for Proposals (RFP)1,200,000 0 1,200,000 144,134 1,055,878 1,200,012 (12)
Other Capital 1,450,000 0 1,450,000 250,000 1,200,000 1,450,000 0
Medicare Part D 150,000 0 150,000 100,000 0 100,000 50,000
Bay Area Consortium for Quality Health 250,000 0 250,000 0 250,000 250,000 0
Administration/Infrastructure Support 0 0 0 63,535 0 63,535 (63,535)
BOS Discretionary Allocation***500,000 500,000 1,000,000 515,585 484,415 1,000,000 0
TOTAL FY 05/06 28,524,532 2,860,000 31,384,532 22,859,945 7,142,959 30,002,904 1,381,628
*Carryover amounts are approved by the BOS.
**Savings are unexpended funds that will revert to the general Measure A account for reallocation.
***The BOS as a whole allocates 25% of Measure A funds. Within this 25%, each Supervisor is allocated $100,000 for
discretionary spending within his or her district—a total of $500,000.
Public Health
PH Prevention Initiative, $3,000,000
Admin/Indigent Health
Bay Area Consortium for Quality Health Care, $250,000
Behavioral Health
Community-Based Organization (CBO)
Providers, $2,250,000
Board of Supervisors, $500,000
Medicare Part D, $150,000
Other Capital, $1,450,000
Capital Request for Proposals, $1,200,000
05/06 Reduction Target, $2,063,820
Insurance Expansion, $250,000
School-Based Health Centers, $1,000,000
Non-County Hospitals, $4,500,000
County Primary Care CBOs, $5,000,000
ER Physician Reimbursement, $1,500,000
05/06 Reduction Target, $1,042,659
Detox/Sober Station, $2,000,000
05/06 Reduction Target, $2,268,053
Medicare Part D, $100,000
Figure 3
FY 05/06 MEASURE A FUNDING ALLOCATIONS ALLOCATED BY THE BOARD OF SUPERVISORS
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FY 06/07 BUDGET INFORMATION
In FY 06/07, the 25% of Measure A revenue allocated by the BOS was budgeted at approximately $27.1
million and was allocated as follows:
Carryover Expended Carryover
FY 06/07 from Total and/or to
Department Allocation Previous FY* Allocation Encumbered Next FY* Total Savings**
Public Health (Total: 4,500,000)
Public Health Prevention Initiative 3,000,000 0 3,000,000 2,852,658 0 2,852,658 147,342
ER Physician Reimbursement 1,500,000 150,000 1,650,000 1,500,000 150,000 1,650,000 0
Behavioral Health (Total: 9,247,572)
CBO Providers 2,650,000 0 2,650,000 2,650,000 0 2,650,000 0
Detox/Sober Station 2,000,000 3,730,000 5,730,000 3,035,000 2,695,000 5,730,000 0
Criminal Justice Screening/
In-Custody Svcs 3,597,572 0 3,597,572 3,597,572 0 3,597,572 0
Mental Health Costs for
Oakland & Glen Dyer Jails 750,000 0 750,000 750,000 0 750,000 0
Mental Health Costs for
Juvenile Justice Center 250,000 0 250,000 0 0 0 250,000
Indigent Health (Total: 12,926,960)
County Primary Care CBOs 6,476,960 0 6,476,960 6,476,960 0 6,476,960 0
Non-County Hospitals 4,500,000 0 4,500,000 4,500,000 0 4,500,000 0
School-Based Health Centers 1,000,000 210,000 1,210,000 954,328 210,000 1,164,328 45,672
Insurance Expansion 250,000 0 250,000 0 0 0 250,000
Administration/Infrastructure Support 200,000 0 200,000 109,506 0 109,506 90,494
Medical Costs for Juvenile Justice Center 500,000 0 500,000 490,977 0 490,977 9,023
Capital Request for Proposals
(FY 05/06 allocation) 1,055,878 1,055,878 1,055,878 0 1,055,878 0
Other Capital (FY 05/06 allocation) 1,200,000 1,200,000 100,000 1,100,000 1,200,000 0
Bay Area Consortium for Quality Health
(FY 05/06 allocation)/Healthy Oakland 250,000 250,000 125,000 125,000 250,000 0
Medicare Part D (FY 05/06 allocation)62,666 62,666 62,666 0 62,666 0
BOS Discretionary Allocation***500,000 484,415 984,415 510,209 474,206 984,415 0
TOTAL FY 06/07 27,174,532 7,142,959 34,317,491 28,770,755 4,754,206 33,524,961 792,530
*Carryover amounts are approved by the BOS.
**Savings are unexpended funds that will revert to the general Measure A account for reallocation.
***The BOS as a whole allocates 25% of Measure A funds. Within this 25%, each Supervisor is allocated $100,000 for
discretionary spending within his or her district—a total of $500,000.
Public Health
PH Prevention Initiative, $3,000,000
Indigent Health
Medical Costs for Juvenile Justice Center, $500,000
Behavioral Health
Community-Based Organization (CBO)
Providers, $2,650,000
Board of Supervisors, $500,000
Administration/Infrastructure Support, $200,000
Insurance Expansion, $250,000
School-Based Health Centers, $1,000,000
Non-County Hospitals, $4,500,000
County Primary Care CBOs, $6,476,960
ER Physician Reimbursement, $1,500,000
Detox/Sober Station, $2,000,000
Criminal Justice Screening/
In-Custody Svcs, $3,597,572
Mental Health Costs for Oakland and
Glen Dyer Jails, $750,000
Mental Health Costs for Juvenile Justice Center, $250,000
Figure 4
FY 06/07 MEASURE A FUNDING ALLOCATIONS ALLOCATED BY THE BOARD OF SUPERVISORS
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FY 05/06 REDUCTION TARGET ALLOCATIONS
The Alameda County budget process requires that each of the County’s departments/agencies prepare what
is called a Maintenance of Effort (MOE) budget for each fiscal year.The departments/agencies use the
following formula to determine MOE budgets:
1. Start with the rollover of existing program/expenditure commitments.
2. Adjust for known cost increases and revenue fluctuations.
3. Further adjust for a cost of living adjustment (COLA) set by the Board of Supervisors (BOS) for the
department’s/agency’s community-based organization (CBO) contracts.
The MOE budgets highlight any revenue gaps that need to be addressed to maintain the department’s/
agency’s service levels from one year to the next.The sum of these MOE gaps plus any one-time-only
revenue contained in the base budget year, less any County discretionary revenue growth, is then used to
define the County’s projected budget deficit for the upcoming year and is the basis for allocating
“reduction targets” for each department/agency.
The formula for the assignment of these “reduction targets” is largely tied to the percentage of County
discretionary funds contained in each department’s/agency’s total budget.These targets form the basis for
each department/agency to submit its recommended “budget balancing” strategies for BOS review and
adoption.
In FY 05/06, Measure A funds were used in part to help achieve reduction target allocations for the Public
Health Department, the Behavioral Health Care Services Department, and the Indigent Health Department
in the following amounts:
Reduction Target Expended and/or Rolled Back into
Department Allocation Encumbered Measure A Reserve
Public Health 1,042,659 142,668 899,991
Behavioral Health 2,268,053 2,268,053 0
Indigent Health 2,063,820 2,063,820 0
MEDICARE PART D SUPPLEMENT
FY 05/06 Allocation:$250,000
Amount Expended/Encumbered:$200,000
The Medicare Part D allocation was a one-time allocation made in FY 05/06.
Medicare Part D,a federal program to subsidize the costs of prescription drugs for Medicare beneficiaries,
went into effect on January 1, 2006. While the new drug benefit aimed to provide much-needed help in
paying for the costs of prescriptions, a certain category of beneficiaries, often referred to as “dual
eligibles,” faced the possibility of having their benefits reduced or made less accessible. Such persons are
those who are covered by both Medicare and Medi-Cal. Before Medicare Part D, medicines for dual
17
eligibles were covered under Medi-Cal; after Part D, medicine coverage was switched to Medicare, with the
result that many patients lost their prescription coverage.
Some of the issues facing dual eligibles included the following:
• Some dual eligibles were enrolled in programs that did not cover all prescriptions they required.
• Others were enrolled in programs that required co-payments of $1-5 per prescription.
• Many dual eligibles, and some other Medicare beneficiaries, face a coverage gap when total drug costs
reach $2,400. Part D requires these beneficiaries to pay 100% of prescription costs until $3,850 is
paid out of pocket.
• Some dual eligibles were not enrolled in a Medicare Part D program at all.
To ensure that mental health clients and all other Alameda County Health Care Services Agency (HCSA)
clients continued to receive their medications, the Alameda County Board of Supervisors (BOS) allocated
$250,000 in Measure A funds to the Alameda Health Consortium and the Alameda County Behavioral
Health Care Services (BHCS) Department. $100,000 was initially allocated to each agency, with the
allocation of the remaining $50,000 to be determined later. Using the $200,000 total initial allocation,
both agencies were able to alleviate some of the challenges surrounding Medicare Part D program
implementation.The $50,000 balance of the original $250,000 allocation reverted to Measure A savings,
to be reallocated.Note that $100,000 represents only 0.4% of the total Measure A funds.
The $100,000 allocation made to the Alameda Health Consortium was to cover the costs of providing one-
on-one enrollment assistance to dual eligible patients; to cover pharmacy co-payments (upon
determination that payment would present an insurmountable barrier to the patient); and to cover
emergency refills (when gaps in coverage occurred).The Alameda Health Consortium assisted
approximately 3,750 dual eligibles through the Medicare Part D enrollment process.
The $100,000 allocation made to the BHCS department was used to cover pharmacy co-payments and to
pay the salary of a pharmacy “Help Desk” employee. From January 2006 through June 2007, almost 1,500
prescriptions were filled using Measure A funds.
While the challenges surrounding the new Medicare Part D program affected patients nationwide, Alameda
County was in the unique position of recognizing the problems early and having a dedicated funding
source, Measure A, to respond.The Medicare Part D allocations were both extremely successful and
extremely cost-effective.
It should also be noted that Supervisor Alice Lai-Bitker allocated $25,000 under the BOS’s discretionary
Measure A funds to support Medicare Part D.The $25,000 provided counseling and enrollment assistance
to seniors and monolingual (non-English speaking) dual eligibles.
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CAPITAL REQUEST FOR PROPOSAL (RFP)
FY 05/06 Allocation:$1,200,000
Amount Expended/Encumbered:$1,200,012
The Capital RFP was a one-time allocation made in FY 05/06.The $1,200,000 allocation was fully
expended and/or encumbered by the end of FY 06/07.
On January 10, 2006, the Alameda County Board of Supervisors (BOS) approved a Capital RFP and directed
$1.2 million from unspent, one-time-only FY 04/05 funds towards capital improvements for community-
based organizations (CBO) that provide health services to County of Alameda indigent, low income,
and/or uninsured populations.
The RFP was in response to the identified and testified needs from the initial Measure A community
hearings. At the hearings, many CBO providers attested that capital funds are scarce and hard to come by—
yet the need for safe and up-to-date facilities is essential to the success of their organizations. Capital needs
include acquisition, construction, existing property renovation or expansion, equipment, and/or
management information.
Eligible health-related facilities included the following nonprofit CBOs:
•AIDS providers
• alcohol and drug organizations
• community health clinics
•mental health providers
CBOs were screened to ensure that they provided health services to Alameda County’s indigent, low
income,and/or uninsured populations.
Health Care Services Agency (HCSA) received a total of 51 proposals from 49 organizations in response to
the RFP.The total amount of funding requested from all proposals was $5,067,388.This clearly represented
the tremendous need for capital funds by our CBOs.
The proposals were reviewed by a panel composed of community and County representatives. Of the 51
proposals submitted, 19 were recommended for funding and approved by the BOS (see Appendix D for a
map of funded agencies):
Award
Agency Amount Purpose Location
Alameda Family Services $75,000 Renovation Alameda
Ann Martin Center $25,000 Management information systems (MIS) Piedmont
Asian Community
Mental Health Services $100,000 Acquisition, equipment purchase Oakland
Asian Health Services $75,000 Renovation, equipment purchase Oakland
Axis Community Health $75,000 MIS Pleasanton
Bonita House $19,134 Renovation Oakland
Building Opportunities
for Self-Sufficiency $50,000 Equipment purchase Berkeley
19
Award
Agency Amount Purpose Location
Center for Elders’ Independence $18,058 Equipment purchase Oakland
Center for the Education
of the Infant Deaf $66,250 Equipment purchase, renovation Berkeley
East Bay Agency for Children $49,570 Equipment purchase, MIS Oakland
Eden Youth and Family Center $40,000 Renovation and expansion Hayward
Friendship House $40,000 Renovation Oakland
HIV Education and Prevention
Project of Alameda County $17,000 Renovation and equipment Oakland
La Clinica de la Raza –
Fruitvale Health Project $100,000 Preconstruction and renovation Oakland
Native American Health Center $100,000 Acquisition Oakland
Options Recovery Services $50,000 Acquisition Berkeley
Thunder Road $75,000 Equipment purchase, renovation Oakland
Tiburcio Vasquez Health Center $100,000 Equipment purchase Union City
Tri-City Health Center $125,000 MIS Fremont
TOTAL $1,200,012
See Appendix C for a description of fund recipients.
Specific examples of the purposes listed above include the following:
•Acquisition:purchase of land or a facility
•Equipment purchase:generally,purchase of large pieces of equipment such as dental chairs,exam
tables, or X-ray machines
•Renovation:renovation of an existing facility or a portion of a facility, for example exam rooms, a
kitchen, or a roof
•MIS:purchase and installation of various Management Information Technology equipment, such as
computers, servers, consultant time, or new billing systems.
The Oversight Committee is concerned that there appears to be no requirement that recipients of capital
funds provide services to indigent, underinsured, or low income patients for a specified period.
20
OTHER CAPITAL PROJECTS
FY 05/06 Allocation:$1,450,000
Amount Expended/Encumbered:$350,000
As indicated in the Capital Request for Proposal section above, during the Measure A community hearings,
community members presented testimony advocating the use of Measure A funds for capital needs. Several
providers and community advocates specifically asked for support of critical capital projects in lieu of
ongoing program support. Key among these projects were the following:
• Valley Care Hospital of Livermore/Pleasanton’s renovation of their emergency room at the Pleasanton
site, estimated at $3 million
• Axis Community Clinic’s partnership expansion with the City of Livermore of their Livermore clinic
site, estimated at $500,000
• Tri-City Homeless Coalition HOPE Project’s replacement of their mobile health clinic operating in the
Tri-City and Tri-Valley areas, estimated at $250,000
• Alameda Hospital’s initial facility acquisition and renovation costs to re-establish primary care clinic
services in their city, estimated at $150,000.
Each organization understood that capital funds would be contingent upon Board of Supervisors (BOS)
approval and the availability of savings from FY 04/05 in the portion of the Measure A account not
designated for the Alameda County Medical Center. Each organization was also sensitive to the varying
needs of our County and appreciative of the BOS obligation to prioritize needs, while recognizing the
BOS’s commitment to a fair and geographic distribution of funds.
Health Care Services Agency (HCSA) made a recommendation to the BOS that these projects be supported
outside the RFP process in the following amounts:
• Valley Care Hospital - $1,000,000
•Axis Community Clinic - $250,000
•Tri-City Homeless Coalition - $100,000
• Alameda Hospital - $100,000.
HCSA made these recommendations based on the importance of the projects and the community support
demonstrated on their behalf. HCSA allocated funds contingent upon the organization’s ability to secure
the remaining revenue needed to purchase or complete the project. HCSA believed that support for these
projects outside an RFP process further balanced the distribution of Measure A funds committed to by the
BOS and strengthened the County’s resolve that Measure A be a countywide initiative addressing the
essential health care needs of all its residents. As with all other requests, it should be noted that each of
these organizations strongly advocated for full funding, and continue to argue for further consideration
within available funds.
At the close of FY 06/07, funds allocated to Axis Community Clinic and Tri-City Homeless Coalition had
been fully expended.The County is currently (FY 07/08) negotiating the contracts for release of funds
allocated to Valley Care Hospital and Alameda Hospital.
The Oversight Committee is concerned that there appears to be no requirement that recipients of capital
funds provide services to indigent, underinsured, or low income patients for a specified period.
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ALAMEDA COUNTY PUBLIC
HEALTH DEPARTMENT:
PREVENTION INITIATIVE
FY 05/06 Allocation:$3,000,000
Amount Expended/Encumbered:$2,767,660
FY 06/07 Allocation:$3,000,000
Amount Expended/Encumbered:$2,852,658
The Alameda County Public Health Prevention Initiative
operated in conformance with Measure A provisions in
both FY 05/06 and FY 06/07.Three million dollars
was allocated in each of the two fiscal years,
representing about 3% of the overall Alameda County
Public Health Department budget.
The Alameda County Public Health Department
Prevention Initiative has been carried out in the
context of an overall vision of comprehensive health
and a developing strategic plan. Measure A funds under
the Public Health Department Prevention Initiative
supported three main priorities: 1) Chronic Disease
and Injury Prevention, 2) Health Inequities and
Community Capacity-Building,and 3) Obesity
Prevention and School Health. As reported by the
Public Health Department, the funding for each of
these priorities is as follows:
Priority FY 05/06 Expended FY 06/07 Expended
Chronic Disease and Injury Prevention $773,492 (28%) $722,717 (25%)
Health Inequities and Community Capacity-Building $1,053,231 (38%) $1,192,312 (42%)
Obesity Prevention and School Health $942,004 (34%) $937,630 (33%)
The programs funded under Measure A are targeted to reducing health disparities. Examples of such
projects funded under each of the priorities are as follows:
CHRONIC DISEASE AND INJURY PREVENTION
•Asthma Start Program provided case management to 210 low-income children diagnosed with
asthma and significantly lowered their rate of Emergency Room (ER) visits and hospitalizations during
case management.
•The Diabetes Program provided in-home case management to 50 clients not covered by any form of
insurance. Its also provided 124 clients with diabetes self-management classes, and started classes in
Punjabi, Hindi, and Farsi.The program was able to significantly reduce ER and hospitalization rates for
these clients.
“…We know that just waiting until
people develop diseases and present
for treatment at our community
clinics and emergency rooms and
then treating them with pills and
technology is not prudent public
policy. Policymakers must see beyond
the immediate crisis and look ahead to
our long-term future. By devoting
resources to the immediate medical
needs while simultaneously investing
in proven preventive strategies,
we will best serve the health needs
of our county.”
— from the Alameda County Public
Health Department Report
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HEALTH INEQUITIES AND COMMUNITY CAPACITY BUILDING
• The Division of Communicable Disease Control and Prevention funded staff to work with the
Immunization Registry, adding 50,000 children and 23 providers from July 2006 to July 2007. Up-
to-date immunization rates for county clinics increased by 10% during this period.
• Healthy Passages implemented a social marketing strategy for Latino and African American teens to
increase preconception decision-making and reduce teen births. Pre/post tests show that clients
exhibited far greater knowledge of protection, prevention, decision making, communication skills, and
knowledge of prevention of pregnancy, AIDS, and sexually transmitted infections (STIs).
• Community Assessment Planning and Evaluation (CAPE) used Measure A funds to support three staff to
implement the Community Capacity Building (CCB) Initiative. Staff worked with two communities
to identify priorities and implement neighborhood development activities aimed at reducing violence
and improving health.
OBESITY PREVENTION AND SCHOOL HEALTH
• Nutrition Services continued to use Measure A funds to promote proper nutrition and physical
activities currently not supported by state funding sources and in expanded geographic regions. Mini-
grants that focused on nutrition and physical activity were provided to the San Antonio and Sobrante
Park communities. Healthy Living Councils that expanded to New Haven Unified School District and
Livermore Unified School District in FY 05/06 were sustained.
•Public Health Nursing staff worked with the Oakland Unified School District (OUSD)Nutrition
Services and the Coordinated School Health Council on establishing salad bars in more than 15
schools. Staff also oversaw the school sector of the Healthy Eating Active Communities collaborative in
the San Antonio district and developed and implemented a diabetes control policy for OUSD,created a
Pediatric Diabetes Coalition, and oversaw the Managing and Preventing Diabetes and Weight Gain
project that was implemented in four elementary schools and targeted 4th graders for body-mass
index (BMI) testing with education and follow-up.
The review criteria used in selection of projects funded by Public Health include consistency with Measure
A requirements , capacity for leveraging funds, and a focus on addressing disparities in health status where
they exist in different groups.
Measure A funds were used to leverage an additional $291,000 in FY 05/06 and $296,000 in FY 06/07.
EMERGENCY ROOM (ER) AND ON-CALL PHYSICIAN COMPENSATION
FY 05/06 Allocation:$1,500,000
Amount Expended/Encumbered:$1,499,095
FY 06/07 Allocation:$1,500,000
Amount Expended/Encumbered:$1,500,000
Funds under the ER and On-Call Physician Compensation allocation were used to partially compensate
physicians working in area emergency rooms who provided care to indigent and uninsured patients.The
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law requires hospital emergency rooms to treat all patients needing urgent care, but doctors receive only
partial payment—if any—for emergency services rendered to these patients.
Measure A helps to fill a funding gap created by state and federal policy. Funding for emergency care
provided by physicians decreased significantly in 1983 when the California Legislature transferred financial
responsibility for providing care to indigent adults from the state to the counties. Payments to private
physicians for emergency care 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.
In FY 05/06 and FY 06/07, a total of $3,109,146 and $3,046,132, respectively, was paid for ER and on-
call physician compensation. Measure A funds accounted for approximately 48% of those funds in FY
05/06 and approximately 49% in FY 06/07.
Payments were made to 23 medical groups and 40 individual physicians in FY 05/06 and to 20 medical
groups and 31 individual physicians in FY 06/07. While the number of medical groups and physicians
who received payment decreased in FY 06/07 compared to FY 05/06, the number of claims paid
increased from 20,430 in FY 05/06 and 21,228 in FY 06/07, representing an increase of approximately
four percent.
MEDICAL COSTS FOR JUVENILE JUSTICE CENTER
UNDER ADMINISTRATION/INDIGENT HEALTH
FY 06/07 Allocation:$500,000
Amount Expended/Encumbered:$490,977
The Board of Supervisors (BOS) allocated $750,000 in FY 06/07 for the provision of medical and mental
health services to youth residing at the new Juvenile Justice Center (JJC).This included $500,000 under
Administration/Indigent Health to provide medical services, and $250,000 to the Alameda County
Behavioral Health Care Services (BHCS) department to provide mental health services (discussed in
“Mental Health Costs for Juvenile Justice Center”).
Of the $500,000 allocation under Administration/Indigent Health, $470,000 was used to fund a portion
of a contract with Children’s Hospital and Research Center of Oakland (CHRCO),the new provider of
medical services at the JJC. Despite the need to rapidly transition the provider of service from the Alameda
County Medical Center (ACMC) to CHRCO, this allocation allowed for a smooth transition and continuity
of care for the youth at JJC.
Another $21,970 was used for the provision of billing services to the Victims of Crime (VOC) unit.This
$21,970 was leveraged to gain an additional $110,000 in funding for the JJC.
NOTE:Funding for the physical and psychiatric medical care for adolescents and for psychiatric medical
care for adults has been contained within the Health Care Services Agency (HCSA) budget for the past four
decades.The responsibility to address program needs in these areas lies, by policy and BOS direction, with
the HCSA.The Oversight Committee’s recommendation to utilize Measure A funds to augment these core
County responsibilities was made in response to the high percentage of youth and adults with behavioral
24
health care problems within the County’s Correctional and Justice systems, and the growing demand for
direct services. Measure A funds allocated supported the medical (physical and psychiatric) service
transformation and integration at the new JJC, and set the stage for enhanced coordination of care upon
discharge. See “Mental Health Costs for Juvenile Justice Center” for more details.
ADMINISTRATION/INFRASTRUCTURE SUPPORT
FY 06/07 Allocation:$200,000
Amount Expended/Encumbered:$109,506
Administration includes support for the Measure A Oversight Committee, assistance in the development
and distribution of its report to the Board of Supervisors (BOS), monitoring of the budget of Measure A
funds not designated for Alameda County Medical Center (ACMC), overseeing special projects, responding
to inquiries about Measure A, and managing contracts—including negotiating scope of work and payment
schedule, developing the actual contract, preparing BOS letters for approval, authorizing payments, and
tracking expenditures—using Measure A funds allocated by the BOS.
In FY 04/05 the BOS approved a $200,000 allocation for Administration and Infrastructure support,
providing that the Measure A revenue generated in FY 04/05 exceeded $20 million. Revenue realized in FY
04/05 was approximately $24 million; therefore, in mid FY 05/06 HCSA hired a Measure A Financial
Manager and expended a total of $63,535 in this category. Although technically the $200,000 budget
adjustment in FY 05/06 was never made,there was sufficient spending authority to incur these
expenditures, and the BOS had previously authorized these expenditures.The FY 06/07 and subsequent
fiscal year allocations include actual budget items for these funds.
$200,000 was allocated in FY 06/07 for support of administration of Measure A.This included $109,031
to pay for one full-time position, including salary and employee benefits, and $475 for refreshment and
mileage expenses.The remaining $90,949 was not spent and reverted back into the general Measure A
account.
ALAMEDA COUNTY BEHAVIORAL HEALTH CARE SERVICES
COMMUNITY-BASED ORGANIZATION PROVIDERS
FY 05/06 Allocation:$2,250,000
Amount Expended/Encumbered:$2,250,000
FY 06/07 Allocation:$2,650,000
Amount Expended/Encumbered:$2,650,000
In FY 05/06, $2,250,000 of Measure A funds was dedicated to Maintenance of Effort (MOE) of
Community-Based Organization (CBO) contract providers.This equates to 0.80% of the aggregate
25
Behavioral Health Care Services (BHCS) budget. About 85% of BHCS services are delivered through
contracts, and maintaining and verifying the integrity of the provider network is an essential objective.
Measure A funding assists in meeting the annual escalation of the costs of providing services.
The BHCS objectives for FY 06/07 were to provide appropriate behavioral health care services, which
minimize hospitalization and reduce the incidence of drug abuse problems, and to provide
individualization of treatment to produce better client outcomes.
For FY 06/07, the $2,650,000 allocation represents 0.80% of the aggregate annual BHCS budget (the
3.1% currently shown in the chart on page 15 represents all Measure A monies received as a percent of the
aggregate BHCS budget).The County’s cost of living adjustments for BHCS are exceeded by increases in
business and facility costs, with the result that employees’ salaries do not keep up with inflation.The loss
of Measure A funding would likely decrease the number of services provided as well as the number of
people seen. Of the approximately 30,000 people seen by BHCS annually, about 350 to 400 people would
not have received non-institutional services.This would result in increased suffering and increased cost due
to institutional care.
Challenges in the BHCS allocation included the BHCS “cost settlement process,” which resulted in the
inability of some of the CBOs to access all of Measure A funds because of the “last dollar” standard.The
BHCS CBO providers receive funding from a variety of sources, including Measure A revenue.The
agreement with the providers was that they would spend all other revenue before using Measure A revenue.
The providers are paid via an allocation formula and then, approximately six months after the close of the
fiscal year,a cost report settlement is conducted to reconcile actual expenditures against all available
revenue. If money is owed to the county, then the Measure A revenue would be the first source of revenue
recouped, and this money would be returned to the Measure A fund.
The cost report settlement process as previously administered proved to be too cumbersome and in conflict
with the intent of the Measure A augmentation that funds are provided to maintain current levels of service
(commonly referred to as “maintenance of effort”).The cost report settlement process has subsequently
been streamlined so that Measure A funds will no longer be recouped; instead, all funds are to be spent for
the purpose for which they were allocated in the year of the allocation. Measure A funds that had been
recouped in FY 04/05 and FY 05/06 in the amount of $1,019,980 were reallocated in FY 07/08
specifically to BHCS CBO providers for capital improvement grants.
ALAMEDA COUNTY BEHAVIORAL HEALTH CARE SERVICES
DETOX/SOBERING STATION
FY 05/06 Allocation:$2,000,000
Amount Expended/Encumbered:$270,000
FY 06/07 Allocation:$2,000,000
Amount Expended/Encumbered:$2,000,000
The Board of Supervisors (BOS) approved a $2,000,000 allocation per fiscal year beginning in FY 04/05
to support the construction of a new Detox/Sobering Station. Unspent funds in a given fiscal year under
this allocation automatically roll into the next fiscal year for the same purpose.
26
In June 2004, a Detox Advisory Board was convened by Supervisor Keith Carson and Health Care Services
Agency (HCSA) Director Dave Kears to explore the need for, type of, and potential locations for new
detoxification services for the residents of Alameda County.This Board included representatives from
Congresswoman Barbara Lee’s office, the cities of Oakland and Berkeley, Alameda County Public Health,
Behavioral Health Care Services (BHCS), and Emergency Medical Services, as well as hospitals, public safety
organizations, and grassroots organizations. An extensive investigation into best practice services
commenced, which included delegations of 23 public officials and a representative from the local business
community, who traveled to Portland, Oregon and Seattle, Washington to learn first-hand how their
exemplary programs operate.The recommendation for new services (modeled on the Portland Program),
adopted by the Detox Advisory Board in February 2005, included Residential Social Model Detoxification
Services, a Sobering Center, and a Transport Van Program to serve the other two programs.
The County Government Services Agency (GSA) initiated a Request for Proposal (RFP) for possible
locations, none of which were acceptable to the communities. After BHCS followed up on numerous leads
over a year, the search resulted in the determination that these new services would exist only if located on
the County’s Fairmont Hospital Campus. On January 31, 2006, the Board of Supervisors approved the
location and development of the facilities for these new services on the Fairmont Campus. An existing
building would be remodeled for the Detox Program, and a new 6,000-square-foot building would be
constructed for the Sobering Center. GSA, through an RFP process for a Design-Build procurement method,
awarded the contract to a local team, Shah-Kawasaki Architects and BBI Construction, in March 2007.
The $270,000 allocation in FY 05/06 was for architectural fees associated with the design/remodel of
both facilities.
In FY 06/07 funds were used for planning and construction of a much-needed detox/sober station.
Factors demonstrating this need include the following:
• the absence of an appropriate location in the past
• the large number of people detoxified in psychiatric emergency rooms and in jail, at great cost and
increased client risk.
In January 2008, construction was competed on the following at the Fairmont Campus on the San
Leandro/Castro Valley border:
• a Sobering Center/Station, with a capacity for 50 clients at any one time for a six-hour stay
• a Detoxification Facility, with a capacity for 32 residents for a stay of three to five days.
The location is on County-owned property and will likely increase transportation costs due to use of the
Transport Van Program. However, police, fire, and emergency departments at psychiatric and medical
hospitals will find savings through significant reductions of their services. Net costs or savings will be
determined after the facilities are operational for a period of time.
Construction began in June 2007, and both facilities opened in January 2008.
27
MENTAL HEALTH COSTS FOR JUVENILE JUSTICE CENTER
FY 06/07 Allocation:$250,000
Amount Expended/Encumbered:$0
$250,000 was allocated specifically to restructure and enhance services provided to youth in the new
Juvenile Justice Center (JJC). Measure A funding allowed additional staff to be added to the Guidance Clinic
so that a therapeutic milieu could be established in each housing unit. Without these funds Behavioral
Health Care Services (BHCS) would have continued to provide only court assessments and crisis
intervention services for youth at the JJC. Future evaluations will be done of the modified services to note
whether these services are affecting recidivism rates and the shift of youth to non-institutional treatment.
The $250,000 allocation was approved late in FY 06/07 and was to be used to hire additional staff at the
Guidance Clinic of the new JJC. Due to Human Resource and Civil Service rules and regulations, additional
staff was not hired until FY 07/08.
MENTAL HEALTH COSTS FOR
OAKLAND AND GLEN DYER JAIL
FY 06/07 Allocation:$750,000
Amount Expended/Encumbered:$750,000
As part of the FY06/07 County Measure A and Health Care
Services Agency (HCSA) Budget review and adoption, the
County Board of Supervisors (BOS) authorized an
augmentation of $750,000 in Measure A funds to support
expanded psychiatric services to adult inmates in the County’s
Santa Rita and North County Correctional facilities.This
augmentation was made to partially address the steady increase
in the inmate population coupled with the impact caused by
the closing of the Oakland City Jail, and the growing
prevalence of mental health problems among the population. It
is estimated that more than 20% of the inmate population has
significant mental health problems. Despite both this population growth and increasing mental health
prevalence, staffing support at both facilities had remained constant for over 20 years, severely
compromising the County’s ability to meet minimum standards for screening and follow-up care.
Measure A augmentation has
resulted in improved services
and response time in the
provision of all psychiatric
services for the County’s
inmate population. For the
first time in over a decade,
there were no suicides
recorded for all of FY 06/07.
28
CRIMINAL JUSTICE SCREENING/IN-CUSTODY SERVICES
FY 06/07 Allocation:$3,597,572
Amount Expended/Encumbered:$3,597,572
The Criminal Justice Screening/In-Custody Services provides all mental health services (including
screening, assessments, and treatment) to more than 700 inmates at any given time who have mental
illness. Since these services are mandated, the funds for providing them would have to use about $5
million of County General Funds.
Measure A funds enabled the service to hire additional staff who could do timely screening to all inmates
at booking. The resulting early detection resulted in a calmer and more stable jail environment and reduced
risk of liability for the County. Next year the service plans to consider the re-opening of an in-patient
treatment unit at the Glen Dyer Jail for inmates with severe mental illness.This could reduce both costs of
“out of County treatment” and recidivism, because of better linking to County services.
BOARD OF SUPERVISORS DISCRETIONARY ALLOCATIONS
FY 04/05 Allocation:$500,000
Amount Expended/Encumbered:$0
FY 05/06 Allocation:$500,000
Amount Expended/Encumbered:$515,585
FY 06/07 Allocation:$500,000
Amount Expended/Encumbered:$510,209
On December 14,2004,the Board of Supervisors (BOS) adopted to receive a discretionary allocation of
$100,000 per district for each fiscal year beginning in FY 04/05, for “other” services. Under this
allocation, each member of the BOS is authorized to recommend appropriations totaling up to $100,000
in each fiscal year.The recommended appropriations require BOS approval.
On March 1, 2005, the BOS approved the distribution of the initial $500,000.The allocation of up to
$500,000 per fiscal year commenced in FY 04/05 and continued in both FY 05/06 and FY 06/07.
The discretionary BOS appropriations were required to meet all the administrative and policy requirements
of Measure A. Supervisors could submit allocation requests at any time during the fiscal years, and could
carry over any unspent or unallocated funds designated for their districts from one fiscal year to the next.
The full BOS approved all contracts recommended by the individual Supervisors.
Because no funds were expended or encumbered in FY 04/05, funds available under the BOS allocation in
FY 05/06 totaled $1,000,000 ($500,000 in FY 04/05 + $500,000 in FY 05/06);thus,the total amount
expended and/or encumbered in FY 05/06 is $515,585.
Similarly,in FY 06/07,the balance of unexpended funds from FYs 04/05 and 05/06 rolled over, thus
allowing for an expenditure/encumbrance amount above the $500,000 FY 06/07 allocation.
29
For fiscal years 05/06 and 06/07, the Board District Allocations were as follows:
LEGEND:
Dist = District District 3 = Supervisor Alice Lai-Bitker
District 1 = Supervisor Scott Haggerty District 4 = Supervisor Nate Miley
District 2 = Supervisor Gail Steele District 5 = Supervisor Keith Carson
Expended/
Dist FY Agency/Contractor Allocated Encumbered Description
1 5/06 Axis Community Center $100,000 $100,000 Livermore Clinic expansion
6/07 Tri-City Homeless Coalition $75,000 $75,000 Purchase of mobile health clinic
6/07 Northern CA Cancer Center $10,000 $10,000 Cancer education
6/07 United Srs of Oakland and AC $5,000 $5,000 Healthy Living Festival expenses
6/07 Tri-Valley Community Foundation $20,000 $20,000 Dental services
6/07 Tri-Valley Community Foundation $6,400 $6,400 School-based health center expenses
6/07 Tri-City Health Center $33,600 $33,600 Diabetes program
TOTAL $250,000 $250,000
2 5/06 St. Rose Hospital $50,000 $50,000 Support for Silva Clinic
5/06 Spectrum Community Services $20,000 $20,000 Senior fall risk reduction
5/06 Tiburcio Vasquez Health Center $30,000 $30,000 Health ed at Tennyson & Logan High
6/07 St. Rose Hospital $50,000 $50,000 Support for Silva Clinic
6/07 Spectrum Community Services $20,000 $20,000 Senior fall risk reduction
6/07 Tiburcio Vasquez Health Center $30,000 $30,000 Health ed at Tennyson & Logan High
TOTAL $200,000 $200,000
3 5/06 Legal Assistance for Seniors $15,000 $15,000 Funds to support Medicare Part D
5/06 Family Bridges $10,000 $10,000 Funds to support Medicare Part D
5/06 HIV Ed and Prevention Program $20,000 $20,000 Harm reduction & prevention services
5/06 Spectrum Community Services $15,000 $15,000 Senior fall risk reduction
6/07 Friendship Lodge $15,000 $15,000 Case manager/counselor
6/07 Spectrum Community Services $15,000 $15,000 Senior fall risk reduction
TOTAL $90,000 $90,000
4 5/06 Livability Health Consultant $95,542 $95,542 Livability Health Consultant: staff
5/06 Technical Assistance Consultant $10,000 $3,000 Technical Assistance Consultant: staff
5/06 Violence Prevention $74,902 $74,902 Violence Prevention: staff
5/06 HIV Ed and Prevention Program $20,000 $20,000 Harm reduction & prevention services
5/06 Family Violence Law Center $20,000 $20,000 Relation abuse prevention
5/06 Spectrum Community Services $10,000 $10,000 Senior fall risk reduction
6/07 Spectrum Community Services $15,000 $15,000 Senior fall risk reduction
6/07 Bay Area Consortium for $50,000 $5,361 Gastrointestinal services
Quality Health
TOTAL $295,444 $243,805
5 5/06 Bay Area Consortium for $100,000 $100,000 Purchase of mobile health
Quality Health clinic services
TOTAL $100,000 $100,000
See Appendix C for a description of fund recipients.
30
Some of the District allocations funded organizations that received other Measure A funds, either directly
or indirectly, including Bay Area Consortium for Quality Health Care, St. Rose Hospital, HIV Education and
Prevention Program,Tri-City Homeless Coalition,Tri-City Health Center,Tiburcio Vasquez Health Center,
the Friendship Lodge, and Axis Community Center.The remaining allocations were to organizations or
services that did not receive other Measure A funding.
The Supervisors report that $679,000 in additional funds were leveraged from the District allocations,
including the following:
• $180,000 from the City of Livermore CDBG for the expansion of the Livermore Clinic
• $10,000 from Kaiser Permanente for the expansion of the Livermore Clinic
• $10,000 from the Tri-Valley Community Foundation for the expansion of the Livermore Clinic
• $29,000 through a mix of community donations and some unrestricted clinic funds for the expansion
of the Livermore Clinic
• $150,000 from a State of California grant in support of the Livability Initiative
• $300,000 from the Koshland fund in support of the Livability Initiatives.
The Measure A Oversight Committee asked
the Supervisors to report on their respective
allocations in the same format as other
recipients of Measure A funds; all but District
2 Supervisor Gail Steele submitted the
requested reports.The reports provide varying
levels of information as to how the allocations
aimed to improve and/or accomplished
improvements in the health of residents in
their respective districts. For example, some
allocations supported expanded space or
staffing capacity in mobile and fixed-site
health care clinics,some supported
distribution of information to special-need
populations, and some aimed to prevent
unsafe and unhealthy behaviors.
In summary, the Committee has the following
observations about the BOS district
allocations.
These allocations:
• augment efforts to disperse Measure A
funds geographically throughout the
County
• provide flexibility in being responsive to
time-sensitive needs
• allow for creativity in addressing unique
local health care issues and needs
•must meet Alameda County Health Care
Services Agency (HCSA) contract,
reporting, and outcome requirements.
BOARD OF SUPERVISORS’
MEASURE A DISTRICT ALLOCATIONS
BOARD MEMBERS’ FUNDING
OBJECTIVES FOR FY 05/06 AND FY 06/07
District 1:To provide an additional funding
source to community-based organizations to
provide health services for indigent residents
of District 1.
District 2: To provide an additional funding
source to community-based organizations to
provide health services for indigent residents
of District 2.
District 3: Based on testimony at Measure A
hearings convened by the Board of Supervisors
and the Alameda County Health Care Services
Agency, funding gaps for the uninsured were
identified. Funds were used to alleviate some
of these funding gaps.
District 4:1) To support the underfunded
public health/prevention component of the
County health care system to create healthy
and livable communities; 2) to support the
underfunded needs of older adults; and 3) to
promote greater geographic resource equity,
particularly in East Oakland and
unincorporated communities.
District 5:To provide mobile health services to
underserved communities.
31
The Committee also has the following concerns:
• There is no specified process to announce the availability of funding or to request a District allocation.
• Allowing allocations to occur on a piecemeal basis at any time throughout the year adds an
administrative burden and is therefore a cost to Measure A.
• Small allocations require a similar amount of County staff time to administer as large allocations;
therefore, the greater the number of separate allocations and contracts, the greater the amount of
overall staff time and Measure A funding is spent on administration rather than service delivery. We
recommend that the BOS be conscious of the cost of administering these grants when making their
allocations.
• Unspent funds carried over from year to year diminish the timely responsiveness of Measure A in
addressing the County’s demanding health care needs, unless the unspent funds are carried over for a
specific funding goal. In some cases, unspent funds are carried over without designation of a funding
goal.
• Because the Committee requested Measure A reports from the Supervisors, rather than from the
recipients of the discretionary funds, the level of detail provided in the reports varied greatly.
NON-COUNTY HOSPITALS
FY 05/06 Allocation:$4,500,000
Amount Expended/Encumbered:$4,500,000
FY 06/07 Allocation:$4,500,000
Amount Expended/Encumbered:$4,500,000
ST.ROSE HOSPITAL
St.Rose, the 175-bed nonprofit hospital, received $2.25 million in Measure A revenue in both FY 05/06
and FY 06/07.St. Rose used the Measure A revenue to secure an additional $1.7 million per fiscal year in
federal matching funds through the Private Hospital Supplemental Payment Program.The Hayward hospital
depends on this supplemental revenue because it receives insufficient reimbursement through Medi-Cal
governmental programs to cover the full cost of care to its low income and uninsured patients.
St. Rose used the combined Measure A and federal matching dollars to maintain its level of inpatient,
outpatient, and emergency services to Hayward-area residents. During the two-year period, St. Rose almost
doubled the number of its cardiac procedures; expanded its medical staff; and served almost 14,000
children in the Silva Pediatric Clinic. In addition, the supplemental funding helped the hospital secure
long-term financing to retrofit its facilities to meet state seismic standards and plan future program
expansion.
CHILDREN’S HOSPITAL AND RESEARCH CENTER
Children’s Hospital and Research Center in Oakland received $2.25 million in Measure A revenue in both
FY 05/06 and FY 06/07. As with St. Rose, the federal government provided an additional $1.7 million per
fiscal year in matching funds, thus increasing the impact of the tax revenue. While Children’s Hospital
serves as a regional pediatric center,children from Alameda County received two-thirds of its outpatient
services and over half of its inpatient care.
32
Children’s Hospital divided the Measure A and federal matching dollars among five outpatient services that
operate at a loss:
• the hospital-based and school-based adolescent clinics
• the emergency department
• the Center for Child Protection
• the hematology/oncology program
• the audiology service.
As a result of the supplemental funding, the hospital doubled the number of visits in its adolescent clinics,
expanded its medical and mental health services to children exposed to abuse and domestic violence,
pioneered new treatments and techniques for children with cancer, and increased the number of surgical
implants to address hearing loss.
SCHOOL-BASED/LINKED HEALTH CENTERS
FY 05/06 Allocation:$1,000,000
Amount Expended/Encumbered:$988,061
FY 06/07 Allocation:$1,000,000
Amount Expended/Encumbered:$954,328
The mission of the Alameda County School Health Services (SHS) Coalition, formerly the School-Based
Health Center Coalition, 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 members accomplish these goals through the
provision of primary and preventative medical care, behavioral health services, health education, and youth
development at the following 11 school-based/linked health centers in Alameda County:
• Alameda Family Services School-Based Health Center (SBHC) Alameda High School (Alameda)
• Alameda Family Services SBHC Encinal High School (Alameda)
•Berkeley High School Health Center (Berkeley)
•Chappell R.Hayes Health Center (West Oakland)
• Logan Health Center (Union City)
Figure 5
ST. ROSE HOSPITAL USE OF MEASURE A FUNDING
TO OBTAIN FEDERAL MATCHING FUNDS
Figure 6
CHILDREN’S HOSPITAL USE OF MEASURE A FUNDING
TO OBTAIN FEDERAL MATCHING FUNDS
$2,500,000
$2,000,000
$1,500,000
$1,000,000
$500,000
$0 Measure A Allocation Federal Match
$2,250,000
$1,687,500
$2,500,000
$2,000,000
$1,500,000
$1,000,000
$500,000
$0 Measure A Allocation Federal Match
$2,250,000
$1,687,500
33
• Roosevelt Health Center (Oakland)
• San Lorenzo High Health Center (San Lorenzo)
• TechniClinic (Oakland)
• Tennyson Health Center (Hayward)
• Tiger Clinic (Oakland)
• Youth UpRising Health Center (East Oakland)
School sites are selected based on the percentage of
students on free lunch programs, school education
performance levels, and other data related to attendance
and graduation rates (e.g. suspensions), coupled with the
site’s facility capacity to accommodate or construct clinic
space and district/principal’s commitment to an integrated
service model. All decisions are made jointly by the school
site, school district administration, and Health Care
Services Agency’s (HCSA’s) school-based/linked services
coalition.
Alameda County SHS Coalition achieved significant
increases in medical, behavioral health services, and health
education by using $1 million in Measure A funding
(approximately 13% of the Coalition’s budget) to leverage
$6,576,350 in FY 05/06 and $6,685,801 in FY 06/07 in
state and federal matching funds.
During FY 05/06 the 11 Health Centers in the Coalition accomplished the following:
• increased overall clinic visits (25,737 visits) over the previous fiscal year by 25%
• served 31% of the overall student population at schools with SBHCs
•increased first aid and medical visits by 13%
•increased mental health visits by 50%
“About 75% of the day, where are
you? School. So it’s a lot easier for
you to go [to the health center] and
get everything taken care of, all at
the snap of a finger, and then you
can go finish your business, whatever
you have to do.”
– Quote from student using
School Health Services
“I am grateful to be able to send
students to the health center. In
particular, I had one student in crisis
who confided in me. I sent her to the
health center and counseling has
helped her deal with her issues. She
is now participating in class and
doing well academically and in her
life as well.”
– Quote from School Staff
Figure 7
ALAMEDA COUNTY SCHOOL HEALTH SERVICES (SHS)
USE OF MEASURE A FUNDING
TO OBTAIN FEDERAL MATCHING FUNDS, FY 05/06
Figure 7
ALAMEDA COUNTY SCHOOL HEALTH SERVICES (SHS)
USE OF MEASURE A FUNDING
TO OBTAIN FEDERAL MATCHING FUNDS, FY 06/07
$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 Federal Match
$1,000,000
$6,685,801
$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 Federal Match
$1,000,000
$6,576,350
34
• increased individual health education visits by 17%.
During FY 06/07 the 11 Health Centers in the Coalition accomplished the following:
• increased overall clinic visits (27,078 visits) over the previous fiscal year by 5%
• served 32% of the overall student population at schools with SBHCs
• increased first aid and medical visits by 4%
• increased mental health visits by 16%
• expanded the Coordinated School Health Program (CSHP) to strengthen and improve the coordination
of health services in Berkeley, Hayward, and Oakland
• implemented health planning initiatives in Tri-Valley and the City of Fremont to develop cross-systems
infrastructures to increase access to quality, culturally appropriate services to adolescents.
PRIMARY CARE COMMUNITY-BASED ORGANIZATIONS
FY 05/06 Allocation:$5,000,000
• $4,753,987 to clinics under the Alameda Health Consortium
•$246,013 to the Bay Area Consortium for Quality Health Care
Amount Expended/Encumbered:$5,000,000
FY 06/07 Allocation:$6,476,960
•$6,012,421 to clinics under the Alameda Health Consortium
•$314,538 to the Bay Area Consortium for Quality Health Care
• $150,000 to be used to provide health services to day laborers
Amount Expended/Encumbered:$6,476,960
ALAMEDA HEALTH CONSORTIUM CLINICS
The Alameda Health Consortium serves as the coordinating
body for eight community health centers that operate nearly
25 clinic sites, including school-based health centers, in all
areas of Alameda County and are an integral part of the health
safety net.The community centers under the Alameda Health
Consortium include the following:
• Asian Health Services
• Axis Community Health
•La Clinica de La Raza
• LifeLong Medical Care
• Native American Health Center
•Tiburcio Vasquez Health Center
• Tri-City Health Center
• West Oakland Health Center.
The Measure A allocation was distributed to the Alameda
Health Consortium’s eight member community clinics in
order to maintain and expand access to services to uninsured
and indigent County residents.These clinics operate 25 sites
“I avoided seeking medical care
for months until I went to the
emergency room and found I
have diabetes. Since then, I
have been getting low-cost
regular care at a community
based health center. Here they
treat you well—before I just
had to guess what to do about
my illness.
— Primary Care CBO Patient
35
that serve over 130,000 patients annually who are primarily people of color (90%) and low income (96%
making below 200% of the federal poverty level). Half of this patient population is uninsured, and 52%
speak a primary language other than English.
The Consortium Clinics, which provide primary care, dental care, and mental health services, used funds to
increase patient visits during FY 05/06 and FY 06/07.
In FY 05/06:
• Consortium member clinics had a total of 77,479 County Medical Services Program (CMSP) visits.
• The number of new visits to clinics was 19,816, which exceeded the targeted number of visits set by
Alameda County.
• Clinics exceeded their new visit target by 62%.
In FY 06/07:
• Consortium member clinics had a total of 82,206 CMSP visits.
• The number of new visits to clinics was 22,614, which exceeded the targeted number of visits set by
Alameda County.
•Clinics exceeded their new visit target by 9%.
Clinics used Measure A funds to enhance/expand clinic facilities and implement programs that reduced
health disparities.These clinics also successfully leveraged funds from foundations and other private and
public organizations for a variety of projects and services, such as enhancing outreach and enrollment
efforts,increasing staff capacity for medical interpretation, providing pharmaceuticals to CMSP patients,
increasing hours at various clinic sites, and offering prenatal educational counseling classes.
BAY AREA CONSORTIUM FOR QUALITY HEALTH CARE (BACQHC)
FY 05/06 Allocation:$246,013
Amount Expended/Encumbered:$246,013
FY 05/06 Allocation from District 5 Board of Supervisors Allocation:$100,000
Amount Expended/Encumbered:$100,000
Funding used to provide mobile health clinic services.
FY 06/07 Allocation: $314,538
Amount Expended/Encumbered:$314,538
FY 06/07 Allocation from District 4 Board of Supervisors Allocation:$50,000
Amount Expended/Encumbered:$5,361
Funding used to provide gastrointestinal services.
FY 06/07 One-Time Allocation:$125,000
Amount Expended/Encumbered:$125,000
Funding used to assist in obtaining clinic status for three clinics under BACQHC.
The Bay Area Consortium for Quality Health Care (BACQHC) seeks to enhance and sustain the quality of
life in our communities by working to assure access to and retention of quality health care.To this end
BACQHC received a total of $790,912 in Measure A funds during FY 05/06 and FY 06/07 (as indicated
above).
36
Highlights include an increase in availability of affordable services at more convenient times, the hiring of
additional staff, and continued training of both permanent and temporary staff members and others.
BACQHC served 815 patients and provided 2,655 visits in FY 05/06 and 842 patients and 2,737 visits in
FY 06/07.The total number of patients served and number of visits provided were funded using the
County’s funds designated for indigent care—including Measure A and non-Measure A funds.
In its last report, which covered FY 04/05 expenditures, the Oversight Committee cited concern that
BACQHC did not provide the detail necessary to verify compliance with Measure A. Despite this concern,
for the current report BACQHC again submitted reports that were not responsive and were inconsistent
with the questions being asked.
Specific concerns include the following:
• The number of contracted visits of indigent patients achieved only 92% of the contract requirement in
FY 05/06, and 89% in FY 06/07.To be considered within compliance, the number of indigent patient
visits must be 95% or more of the contract requirement.
• The expenditure of $125,000 to obtain accreditation of three clinics—Ujima, Doctor Watson, and
Healthy Oakland/Save a Life—resulted in only one of the clinics, Ujima, receiving accreditation.The
other two did not.
•The reported increases of 27% in patient visits and 30% in patient services need explanations as to
how they were achieved and whether the patients mentioned were indigent patients.
• The reporting provided by BACQHC has consistently failed to meet the Committee’s reporting
compliance guidelines, which require that reports contain Measure A-related information only.
BACQHC reports continually include non-Measure A issues.
While BACQHC continues to receive an allocation under primary care, the agency has not received
additional one-time only funding.
HEALTHY OAKLAND
FY 06/07 One-Time Allocation:$125,000
Amount Expended/Encumbered:$0
The $125,000 allocation to Healthy Oakland was a redirection of funds originally allocated for insurance
expansion.The Board of Supervisors (BOS) initially recommended that $250,000 of non-Alameda County
Medical Center (ACMC) Measure A funds should be used to support children and youth health insurance
program.This recommendation was based on Alameda County being granted pilot status to expand the
State/Federal Healthy Families enrollment, subject to matching County dollars.
As originally conceived, the commitment of $250,000 would provide the 40% match required by the
program and would substantially expand health insurance for low income children and youth.
Unfortunately, the pilot program was initiated with a high state administrative fee, essentially negating the
value of the program.
The BOS decided to redirect the funds based on hearings regarding the initial allocation of the funds,
during which strong public advocacy claimed that not enough Measure A funds were earmarked to new
and/or developing providers of color. Specifically, strong arguments were made to focus new or expanded
services on single adults of color in East and West Oakland.
37
As a result of the hearings, the BOS designated Bay Area Consortium for Quality Health Care (BACQHC)
and negotiated contracts with the agency focusing on the development of new clinic sites and support for
existing outreach and mobile clinic services (see “Bay Area Consortium for Quality Health Care” for more
information). Because of complications and compliance concerns that arose during the first two years of
operation, some program/performance modifications were made, and ultimately the new clinic site
component of the BACQHC initial contract was separated into its own project.
For FY 07/08, the BOS recommended and adopted an allocation of $125,000 to support Healthy Oakland
in developing its infrastructure (the remaining $125,000 was allocated to BACQHC). Since this contract
was not executed until FY 07/08, it will be reviewed in the Oversight Committee’s report of FY 07/08
expenditures.
38
39
SECTION 4
CONCERNS
In developing this report, the Oversight Committee has identified the following concerns regarding health
care funding in general, and Measure A funding specifically:
• The rate at which sales tax receipts increased from FY 05/06 to FY 06/07 was lower than the rate of
increase from FY 04/05 to FY 05/06, meaning that the rate of Measure A funding increases has gone
down accordingly.
•Trends in federal and state funding show cuts in health care spending, creating concern over the
impacts such cuts may have in Alameda County.
• The number of uninsured county residents is growing as employers dilute or drop health insurance
coverage for their workers. As the number of uninsured and underinsured patients grows, Alameda
County’s medical institutions will shoulder most of the strain.
• Outpatient clinic visits at Alameda County Medical Center (ACMC) declined in FY 06/07 as compared
to FY 05/06 despite increased overall funding, which is only partially explained by the transfer of
responsibility of the Juvenile Hall clinic.The decline as well as the lack of explanation for it in the
reporting are both of concern to the Oversight Committee.
•We are concerned that there appears to be no requirement that recipients of capital funds provide
services to indigent,underinsured,or low-income patients for a specified period.
• Regarding Board of Supervisor (BOS) discretionary allocations, we note the following concerns:
-There is no specified process to announce the availability of funding or to request a District
allocation.
-Allowing allocations to occur on a piecemeal basis at any time throughout the year adds an
administrative burden and is therefore a cost to Measure A.
-Small allocations require a similar amount of County staff time to administer as large allocations;
therefore, the greater the number of separate allocations and contracts, the greater the amount of
overall staff time and Measure A funding is spent on administration rather than service delivery.
- Unspent funds carried over from year to year diminishes the timely responsiveness of Measure A in
addressing the County’s demanding health care needs, unless they are carried over for a specific
funding goal;there are unspent funds being carried over without designation of a funding goal.
-Because the Committee requested Measure A reports from the Supervisors, rather than from the
recipients of the discretionary fund, the level of detail provided in the reports varied greatly.
• We cited in our last report (of FY 04/05 expenditures) concern over the lack of detail provided by Bay
Area Consortium for Quality Health Care (BACQHC) necessary to verify compliance with Measure A.
Although this concern was cited in the last report,BACQHC again submitted reports that were not
responsive and inconsistent with the questions being asked. Specific concerns include the following:
-The number of contracted visits of indigent patients achieved only 92% of the contract requirement
in FY 05/06, and 89% in FY 06/07.To be considered within compliance, the number of indigent
patient visits must be 95% or more of the contract requirement.
40
- The expenditure of $125,000 to obtain accreditation of three clinics—Ujima, Doctor Watson, and
Healthy Oakland/Save a Life—resulted in only one of the clinics, Ujima, receiving accreditation.The
other two did not.
- The reported increases of 27% in patient visits and 30% in patient services need explanations as to
how they were achieved and whether the patients mentioned were indigent patients.
- The reporting provided by BACQHC has consistently failed to meet the Committee’s reporting
compliance guidelines, which require that reports contain only Measure A-related information.
BACQHC reports continually include non-Measure A issues.
• The language of Measure A prohibits the replacement of ongoing County funding to the Alameda
County Medical Center (ACMC) by Measure A tax receipts. It also requires that if the County shall be
required to reduce budgetary expenditures in any given year, any reduction in County funding of
ACMC shall be proportionate to reductions in funding of all other health care programs provided by
the County (such as public health, behavioral care, etc.).
The Oversight Committee is concerned that it does not have adequate information to ensure the BOS
that such replacement or substitution of County funds (also called supplantation) with Measure A
funds is not occurring. We plan to further address this important issue in the
coming year.
• 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.This concern was noted in our previous
report also.
41
APPENDIX A:Measure A Revenue Received in FY 05/06 and FY 06/07
APPENDIX B:FY 05/06 and FY 06/07 Measure A Fund Distribution
by Provider or Program
APPENDIX C:Measure A Service Provider Program Descriptions
APPENDIX D:Maps: Geographic Distribution of Providers Receiving Measure A
Funds in FY 05/06 and FY 06/07
Map 1:County, Private, and Nonprofit Hospitals and Alameda County Public
Health Programs That Received Measure A Funds in FY 05/06 and
FY 06/07
Map 2:Alameda County Health Care Services Agency
FY 05/06 and 06/07 Measure A Capital RFP Fund Recipients
Map 3:Emergency Rooms Where ER and On-Call Physicians Provided
Service and Were Compensated With Measure A Funds in
FY 05/06 and FY 06/07
Map 4:Alameda County Behavioral Health Care Services Alcohol
and Drug Providers That Received Measure A Funds in
FY 05/06 and FY 06/07
Map 5: Alameda County Behavioral Health Care Services Mental Health CBO
Providers That Received Measure A Funds in
FY 05/06 and FY 06/07
Map 6: Adolescent School-Based Health Centers That Received Measure A
Funding in FY 05/06 and FY 06/07
Map 7:Primary Care Community Based Organization (CBO) Clinics Receiving
Measure A Funding in FY 05/06 and FY 06/07
APPENDICES
42
43
APPENDIX A:
MEASURE A REVENUE RECEIVED IN FY 05/06 AND FY 06/07
FISCAL YEAR 04/05
County
Date Month ACMC Cumulative Total
Received Earned ACMC County Total 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
County
Date Month ACMC Cumulative Total
Received Earned ACMC County Total 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
44
FISCAL YEAR 06/07
County
Date Month ACMC Cumulative Total
Received Earned ACMC County Total Total Total Cumulative
09/22/06 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
County
Date Month ACMC Cumulative Total
Received Earned ACMC County Total Total Total Cumulative
09/26/07 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//08 05/08 0
08//08 06/08 0
Interest earned 358,317 358,317
TOTAL 72,968,508 24,681,152 97,649,660
GRAND TOTAL 312,503,976 105,679,848 418,183,824
45
APPENDIX B:
FY 05/06 AND FY 06/07 MEASURE A FUND DISTRIBUTION
BY PROVIDER OR PROGRAM
FY 05/06 FY 06/07
Measure A Expended/ Measure A Expended/
Allocation Encumbered Allocation Encumbered
PUBLIC HEALTH
Public Health Prevention Initiative
Chronic Disease and Injury Prevention
Project New Start $16,917 $23,713 $16,917 $13,889
Community Designed Initiative $125,000 $125,000 $125,000 $125,000
Asthma $211,542 $196,577 $211,542 $211,576
Diabetes $261,404 $164,928 $262,028 $221,399
Healthy Kids, Healthy Teeth $147,836 $144,590 $147,212 $150,510
EMS $100,000 $100,000 $100,000 $0
Health Inequities and Capacity Building
Community Designed Initiative $50,000 $0 $50,000 $50,000
Office of Director/CAPE $640,569 $599,633 $630,569 $665,111
Community Nursing $98,508 $98,140 $98,508 $98,510
Immunization Registry $197,263 $179,654 $197,263 $187,662
HIV Prevention $82,800 $88,800 $92,800 $92,489
FHS-Healthy Passage System of Care $98,465 $98,201 $98,465 $98,198
Obesity Prevention and School Health
Nutrition Services $397,306 $369,706 $397,306 $386,880
PH Nursing $177,390 $179,718 $177,390 $176,435
Community Designed Initiative $395,000 $399,000 $395,000 $374,999
TOTAL $3,000,000 $2,767,660 $3,000,000 $2,852,658
Public Health FY 05/06 Reduction Target $1,042,659 $142,668 $0
FY 05/06 FY 06/07
Measure A Number of Measure A Number of
Allocation Claims Paid Allocation Claims Paid
ER and On-Call Physician Reimbursement
Funds expended based on claims submitted by providers; specific allocations were not made for each provider.
Oakcare Medical Group Inc $380,002 6,460 $181,423 4,053
Berkeley Emergency Medical Group $359,467 5,309 $469,348 6,789
California Emergency Physicians $270,318 3,919 $337,029 4,731
Phoenix Emergency Physicians $110,502 1,833 $129,880 2,084
Emergency Medical Assoc of Children $81,334 1,687 $109,385 1,886
Raveendra Nadaraja MD $65,921 81 $43,890 52
R Scott Snyder MD Inc. $28,332 69 $24,351 73
Pleasanton Emergency Medical Group $26,899 472 $63,881 977
TOTAL FOR ABOVE 8 PROVIDERS $1,322,775 19,830 $1,359,187 20,645
TOTAL FOR PROVIDERS RECEIVING
UNDER $20,000 (46 in FY 05/06; 33 in FY 06/07)$176,320 601 $140,813 583
GRAND TOTAL FOR ALL PROVIDERS $1,499,095 20,431 $1,500,000 21,228
46
FY 05/06 FY 06/07
Measure A Expended/ Measure A Expended/
Allocation Encumbered Allocation Encumbered
ADMIN/INDIGENT HEALTH
Bay Area Consortium for Quality Health Care*$250,000 $0 $0 $125,000
Medicare Part D*$250,000 $137,334 $0 $62,666
Other Capital*$1,450,000 $250,000 $0 $100,000
Capital Request for Proposal*$1,200,000 $144,134 $0 $1,055,878
Indigent/Admin FY 05/06 Reduction Target $2,063,820 $2,063,820 $0
Insurance Expansion $250,000 $0 $250,000 $0
Administration/Infrastructure Support $0 $63,535 $200,000 $109,506
Medical Costs for JJC $0 $0 $500,000 $490,977
School-Based Health Clinics (SBHCs)
Maintaining Existing Services
Base Funding for Existing SBHCs $220,000 $217,961 $220,000 $218,000
One-Time Only Capacity Building Grants $0 $0 $0 $0
Core Evaluation $129,659 $129,659 $150,000 $150,000
Service Expansion
Planning and Base Funding for 2 New SBHCs $200,000 $169,576 $200,000 $124,079
Coordinated School Health Sites $162,370 $162,370
Data Needs Assessment and
Planning Technical Assistance $110,171 $105,438 $112,000 $105,174
One-Time Only Service Expansion Grants $0 $0 $0 $0
Capital Reserve $0 $50,000 $0 $50,000
Service System Coordination
Fund Development $7,550 $7,550 $200,834 $200,834
Program Coordination $84,500 $80,237 $31,394 $31,394
Administrative Infrastructure and Support $84,800 $64,320 $75,000 $64,075
One-Time Only Strategic Planning Grants
Professional Development and Training $950 $950 $10,772 $10,772
TOTAL $1,000,000 $988,061 $1,000,000 $954,328
Private and District Hospitals
Children’s Hospital Oakland $2,250,000 $2,250,000 $2,250,000 $2,250,000
St. Rose Hospital $2,250,000 $2,250,000 $2,250,000 $2,250,000
TOTAL $4,500,000 $4,500,000 $4,500,000 $4,500,000
Primary Care CBOs
Asian Health Services $726,093 $726,093 $906,740 $906,740
Bay Area Consortium for Quality Health Care $246,013 $246,013 $314,538 $314,538
AXIS Community Health Center $420,626 $420,626 $520,221 $520,221
La Clinica de la Raza $1,051,147 $1,051,147 $1,279,930 $1,279,930
Life Long Medical Care $712,341 $712,341 $881,002 $881,002
Native American Health Center $321,859 $321,859 $399,915 $399,915
Tri-Cities Health Center $515,642 $515,642 $764,352 $764,352
47
FY 05/06 FY 06/07
Measure A Expended/ Measure A Expended/
Allocation Encumbered Allocation Encumbered
ADMIN/INDIGENT HEALTH
Primary Care CBOs (continued)
Tiburcio Vasquez Health Center $525,643 $525,643 $646,685 $646,685
West Oakland Health Center $480,636 $480,636 $613,577 $613,577
Day Workers $150,000 $150,000
TOTAL $5,000,000 $5,000,000 $6,476,960 $6,476,960
BEHAVIORAL HEALTH
Community-Based Organization Providers
Alameda County Network of
Mental Health Clients $58,997 $48,313 $62,841 $62,841
Ann Martin Children's Center, Inc. $9,835 $9,845 $20,813 $20,813
Asian Community Mental Health Services $59,060 $59,060 $74,237 $74,237
Asian Pacific Psychological Services $4,396 $4,396 $5,489 $5,489
Axis Community Health, Inc.$10,761 $21,521 $26,872 $26,872
BACS $83,014 $99,048 $115,925 $115,925
Berkeley Addiction Treatment
Services, Inc. (B.A.T.S.) $5,104 $5,104 $6,077 $6,126
Berkeley Place $25,700 $25,700 $32,091 $32,091
Bi-Bett Corporation $33,631 $33,631 $41,993 $41,993
Bonita House $55,928 $55,928 $69,835 $69,835
Building Opportunities for
Self Sufficiency (B.O.S.S.)$69,491 $59,491 $74,283 $74,283
Carnales Unidos Reformando
Adictos, Inc. (C.U.R.A.)$18,930 $18,930 $23,636 $23,884
Center for Independent Living $1,988 $1,988 $2,483 $2,483
Community Counseling and
Education Center (C.C.E.C.) $22,164 $22,164 $27,675 $27,675
Crisis Support Services $26,841 $26,841 $33,515 $33,515
Davis Street Community Center $9,323 $9,323 $11,642 $11,642
East Bay Agency for Children $54,241 $54,241 $69,220 $69,220
East Bay Asian Youth Center $2,596 $2,596 $3,241 $3,241
East Bay Community Recovery Project $42,225 $42,225 $95,975 $95,975
Family Paths (formerly Parental Stress) $17,910 $17,910 $28,602 $28,602
Filipinos for Affirmative Action $1,946 $1,946 $2,431 $2,431
Fred Finch Youth Center $30,073 $30,073 $43,413 $43,413
Health and Human Resource Education Center $5,347 $4,344 $5,424 $5,722
Horizon Services $95,000 $95,000 $118,432 $118,432
Humanistic Alternatives to Addiction,
Research, and Treatment, Inc. (HAART) $2,675 $2,675 $3,340 $3,410
La Cheim $36,436 $36,436 $45,849 $35,914
La Clinica $42,568 $42,568 $69,279 $69,279
La Familia $54,693 $54,693 $67,601 $67,601
*Unspent funds in these allocations are allowed to roll forward into subsequent years.
48
FY 05/06 FY 06/07
Measure A Expended/ Measure A Expended/
Allocation Encumbered Allocation Encumbered
BEHAVIORAL HEALTH
Community-Based Organization Providers (continued)
Latino Commission $52,137 $52,137 $65,102 $65,102
Lincoln Child Center $44,537 $44,537 $61,167 $61,167
Magnolia Recovery Program, Inc. $4,367 $4,367 $5,453 $5,453
Mental Health Association $38,184 $38,362 $46,886 $46,886
Native American Health Center $5,956 $5,956 $7,437 $7,437
New Bridge Foundation Inc. $39,010 $39,010 $48,712 $48,712
Oakland Independent Support Center $6,081 $0
Regents of the UC - Center on Deafness $6,738 $6,738 $8,414 $8,414
RL Geddins Women’s Empowerment Network $4,969 $4,640
Second Chance $60,980 $60,980 $76,143 $76,143
Seneca Center $38,333 $38,333 $62,597 $62,597
Senior Support Programs
(formerly Tri-Valley Community Foundation) $1,869 $1,869 $2,334 $2,334
St. Mary's Recovery Center $3,375 $3,375 $104,214 $104,214
Solid Foundation $48,613 $48,613 $60,698 $60,698
STARS $23,174 $23,174 $28,861 $28,861
Supplement Rate Program $38,934 $47,561 $48,615 $48,716
Telecare $819,339 $819,339 $803,994 $803,994
Thunder Road $10,659 $10,659 $13,292 $13,292
West Oakland Health Center $122,539 $122,539 $154,309 $154,309
Y.M.C.A. $8,181 $8,181 $10,216 $10,439
ZDK, Inc. $1,076 $1,076 $1,344 $1,054
TOTAL BHCS CBO MOE $2,250,000 $2,250,000 $2,650,000 $2,650,000
Detoxification/Sober Station $2,000,000 $270,000 $3,035,000 $3,035,000
Criminal Justice Screening (Budget Strategy)$3,597,572 $3,597,572
BHCS FY 05/06 Reduction Target $2,268,053 $2,268,053 $0
Mental Health Costs for Oakland & Glen Dyer Jails $750,000 $750,000
Mental Health Costs for Juvenile Justice Center $250,000 0
BOARD OF SUPERVISORS (BOS)
BOS Discretionary Allocations**$500,000 $515,585 $500,000 $510,209
**FY 04/05 allocation of $500,000 was not expended or encumbered and allowed to roll forward into
subsequent years.
49
APPENDIX C:
MEASURE A SERVICE PROVIDER PROGRAM DESCRIPTIONS
Comprehensive Alcohol Community Mental Community
Medical & Drug Health Health Based
Services Treatment Clinic Provider Org.
Alameda County Network
of Mental Health Clients X
Alameda Hospital X
Alameda Family Services
(formerly Change Thru Xanthos) X
Ann Martin Children's Center, Inc. X
Asian Community Mental Health Services
- AOD - Adolescent Outpatient X X
Asian Health Services X
Asian Pacific Psychological Services X
AXIS Community Health Center X X
BACS X
Base Funding for Existing SBHCs X X
Bay Area Consortium for Quality Health Care X
Berkeley Addiction Treatment Services, Inc. X
Berkeley Emergency Medical Group X
Berkeley Place X
Bi-Bett Corporation X
Bonita House X
Building Opportunities for Self Sufficiency X X
California Emergency Physicians X
Carnales Unidos Reformando Adictos, Inc. X
Center for the Education of the Infant Deaf X
Center for Elder's Independence X
Center for Independent Living X
Children’s Hospital Oakland X
Community Counseling and Education Center X
Crisis Support Services X
Davis Street Community Center X
Detoxification/Sober Station X X
50
Comprehensive Alcohol Community Mental Community
Medical & Drug Health Health Based
Services Treatment Clinic Provider Org.
East Bay Agency for Children X
East Bay Asian Youth Center - AOD -
Primary Prevention X
East Bay Community Recovery Project X X
Eden Youth and Family Center X
Emergency Medical Association of Children X
Family Bridges X
Family Violence Law Center X
Family Paths (formerly Parental Stress) X
Filipinos for Affirmative Action X
Fred Finch Youth Center X
Friendship House X
Friendship Lodge X
Health and Human Resource Education Center X X
Healthy Oakland X
HIV Education and Prevention Project of
Alameda County (HEPPAC)X
Horizon Services X
Humanistic Alternatives to Addiction,
Research, and Treatment, Inc. (HAART) X
La Cheim X
La Clinica de la Raza X X
La Familia X
Latino Commission X
Legal Assistance for Seniors X
Life Long Medical Care X X
Lincoln Child Center X
Magnolia Recovery Program, Inc. X
Mental Health Association X
Native American Health Center X X X
New Bridge Foundation Inc.X
Northern CA Cancer Center X
51
Comprehensive Alcohol Community Mental Community
Medical & Drug Health Health Based
Services Treatment Clinic Provider Org.
Oakcare Medical Group Inc X
Oakland Independent Support Center X
Options Recovery Services X
Phoenix Emergency Physicians X
Pleasanton Emergency Medical Group X
Private and District Hospitals X
R Scott Snyder MD Inc. X
Raveendra Nadaraja MD X
Regents of the UC - Center on Deafness X
RL Geddins Women's Empowerment Network X
Second Chance X
Seneca Center X
Senior Support Programs
(formerly Tri-Valley Community Foundation) X
Solid Foundation X
Spectrum Community Services X
St. Mary's Recovery Center X
St. Rose Hospital X
STARS X
Supplement Rate Program X
Telecare X
Thunder Road X
Tiburcio Vasquez Health Center X
Tri-Cities Health Center X
Tri-City Homeless Coalition X
Tri-Valley Community Foundation X
United Seniors of Oakland and
Alameda County X
Valley Care Hospital X
West Oakland Health Center X X X
Y.M.C.A.X
ZDK, Inc. X
OAKLANDALAMEDA
NEWARK FREMONT
UNION
CITY
HAYWARD
PLEASANTON
CASTRO VALLEY
DUBLINSAN
LEANDRO LIVERMORE
BERKELEY
Children's Hospital
St. Rose Hospital
Eastmont Wellness Center
Highland Hospital
Newark Health Center
Winton Wellness Center
John George Psychiatric Pavilion
Fairmont Hospital
100 Black Men
"I Want To, I Can" - Public Health Institute
DOOF Vignettes - How Now Productions
Center for Career Development in Health Professions - BACQHC
Critical Mass Health Conductors - Bay Area Black United Fund
Pipeline Project - Alta Bates Summit Medical Center
Cycles of Change - Oasis High School
Alameda County Public Health Department
"Get Fit" - La Clinica de la Raza
Healthy Oakland
Tiburcio Vasquez Health Center
La Familia Counseling Service
July 8, 2008Prepared by: Alameda Co. Health Care Services Administration
County, Private and Non-Profit Hospitals and
Alameda County Public Health Programs that
Received Measure A Funds in FY 05/06 & 06/07
Appendix D: Maps
hospitals.wor
Provider City
Highland Hospital Oakland
John George Psychiatric Pavil San Leandro
Fairmont Hospital San Leandro
Eastmont Wellness Center Oakland
Winton Wellness Center Hayward
Newark Health Center Newark
Provider City
Pipeline Project - Alta Bates Summit Medical Cen Oakland
Center for Career Development in Health Profess Oakland
Critical Mass Health Conductors - Bay Area Blac Oakland
DOOF Vignettes - How Now Productions Berkeley
La Familia Counseling Service Hayward
Healthy Oakland Oakland
"Get Fit" - La Clinica de la Raza Oakland
Cycles of Change - Oasis High School Oakland
100 Black Men Oakland
"I Want To, I Can" - Public Health Institute Oakland
Students Run Oakland Oakland
Tiburcio Vasquez Health Center Union City
Alameda County Public Health Department Oakland
Provider City
St. Rose Hospital Hayward
Children's Hospital Oakland
Alameda County Medical Center Hospitals
Public Health Programs
Private Hospitals
O A K L A N D
A L A M E D A
B E R K E L E Y
L I V E R M O R E
H A Y W A R D
U N I O N C I T Y
P L E A S A N T O N
F R E M O N T
S A N
L E A N D R O
C A S T R O V A L L E Y
N E W A R K
D U B L I N
HIV Education an Prevention Project of Alameda County (HEPPAC)
Friendship House
East Bay Agency for Children
Ann Martin Center
Thunder Road
Native American Health Center
La Clinica de la Raza - Fruitvale Health Project
Bonita House
Options Recovery Services
Center for Elders' Independence
Asian Community Mental Health Services
Asian Health Services
Building Opportunities for Self Sufficiency
Center for the Education of the Infant Deaf
Axis Community Health
Eden Youth and Family Center
Tiburcio Vasquez Health Center
Tri-City Health Center
Alameda Family Services
Agency Award
Alameda Family Services 75,000
Ann Martin Center 25,000
Asian Community Mental Health Services 100,000
Asian Health Services 75,000
Axis Community Health 75,000
Bonita House 19,134
Building Opportunities for Self Sufficiency 50,000
Center for Elders' Independence 18,058
Center for the Education of the Infant Deaf 66,250
East Bay Agency for Children 49,570
Eden Youth and Family Center 40,000
Friendship House 40,000
HIV Education an Prevention Project of Alameda County (HEP 17,000
La Clinica de la Raza - Fruitvale Health Project 100,000
Native American Health Center 100,000
Options Recovery Services 50,000
Thunder Road 75,000
Tiburcio Vasquez Health Center 100,000
Tri-City Health Center 125,000
Alameda County Health Care Services Agency
2005-2006 Measure A Capital RFP Fund Recipients
Prepared by: Alameda County Health Care Services Administration July 8, 2008
OAKLAND
SAN
LEANDRO
ALAMEDA
DUBLINCASTRO VALLEY
UNION
CITY
PLEASANTON
HAYWARD
LIVERMORE
BERKELEY
NEWARK
FREMONT
Valley Care Hospital
Alameda Hospital
Washington Hospital
Eden Medical Center
San Leandro Hospital
St. Rose Hospital
Alameda County Medical Center
Summit Medical Center
Children's Hospital Oakland
Alta Bates Summit Medical Center
July 8, 2008Prepared by: Alameda Co. Health Care Services Administration
EMERGENCY ROOMS WHERE ER AND ON-CALL PHYSICIANS
PROVIDED SERVICE AND WERE COMPENSATED
WITH MEASURE A FUNDS IN FY 05/06 & 06/07
Appendix D: Maps
er.wor
SAN
LEANDRO
NEWARK
HAYWARD
OAKLANDALAMEDA
BERKELEY
LIVERMORE
PLEASANTON
DUBLINCASTRO VALLEY
UNION
CITY
FREMONT
July 8, 2008Prepared by: Alameda Co. Health Care Services Administration
Alameda County Behavioral Health Care Services
Alcohol and Drug Providers that
Received Measure A Funds in FY 05/06 & 06/07
Appendix D: Maps
Organization City
Asian Community Mental Health Services Oakland
Asian Pacific Psychological Services Oakland
Axis Community Health, Inc. Pleasanton
Berkeley Addiction Treatment Services, Inc. (Berkeley
Bi-Bett Corporation Oakland
Building Opportunities for Self Sufficiency (B.Berkeley
Carnales Unidos Reformando Adictos, Inc. Fremont
Change Thru Xanthos, Inc. Alameda
Community Counseling and Education Cente Fremont
Davis Street Community Center San Leandro
East Bay Asian Youth Center Oakland
East Bay Community Recovery Project Oakland
Filipinos for Affirmative Action Union City
H.A.A.R.T. - Hayward Hayward
Health and Human Resource Education Cent Berkeley
Horizon Services Oakland
Latino Commission Oakland
Magnolia Recovery Program, Inc. Newark
New Bridge Foundation Inc. Berkeley
RL Geddins Women's Empowerment Networ Oakland
Second Chance Hayward
St. Mary's Recovery Center-Recovery 55 Oakland
The Solid Foundation Oakland
Thunder Road - Adolescent Treatment Cente Oakland
Tri-Valley Community Foundation-Senior Sup Pleasanton
Urban Indian Health Board Oakland
West Oakland Health Council, Inc. Oakland
YMCA Of The East Bay-East Lake Oakland
ZDK, Inc.-The 14th St. Clinic Oakland
bhcs.wor:2
SAN
LEANDRO
NEWARK
HAYWARD
OAKLANDALAMEDA
BERKELEY
LIVERMORE
PLEASANTON
DUBLINCASTRO VALLEY
UNION
CITY
FREMONT
Alameda County Behavioral Health Care Services
Mental Health CBO Providers that
Received Measure A Funds in FY 05/06 & 06/07
Adult Providers
Organization City
Alameda County Network of Mental Heal Oakland
Asian Community Mental Health Service Oakland
BACS Oakland
BACS-Irivington Fremont
Berkeley Place-Casa DeLa Vida Oakland
Bonita House Berkeley
BOSS Oakland
Center for Independent Living Berkeley
Change Thru Xanthos, Inc Oakland
Coalition for Alternatives in Mental Health Berkeley
Crisis Support Services Oakland
East Bay Community Recovery Project Oakland
Health and Human Resource Education Berkeley
La Clinica Oakland
Lifelong Medical Care Berkeley
Mental Health Association Oakland
Native American Health Center Oakland
Oakland Independent Support Center Oakland
Regents of the UC - Center on Deafness San Leandro
Supplement Rate Program San Leandro
Telecare Oakland
Organization City
Ann Martin Children's Center, I Piedmont
East Bay Agency for Children Oakland
Fred Finch Youth Center Oakland
La Cheim Oakland
La Familia Hayward
Lincoln Child Center Oakland
Parental Stress-Oakland Oakland
Seneca Center San Leandro
STARS San Leandro
West Oakland Health Center Oakland
Child Providers
Appendix D: Maps
July 8, 2008Prepared by: Alameda Co. Health Care Services Administrationbhcs.wor:1
SAN
LEANDRO
HAYWARD
ALAMEDA
OAKLAND
CASTRO VALLEY
DUBLIN
PLEASANTON
UNION
CITY
BERKELEY
LIVERMORE
NEWARK
FREMONT
Youth Uprising Health Center
San Lorenzo High Health Ctr
Tennyson Health Center
Fremont High Tiger Clinic
Tri-High Health Services
Alameda Family Services SBHC
Roosevelt Health Center.
McClymonds Health Center
Oakland TechniClinic.
James Logan Health Center
Berkeley High Health Center
July 8, 2008Prepared by: Alameda Co. Health Care Services Administration
ADOLESCENT SCHOOL-BASED HEALTH CENTERS THAT
RECEIVED MEASURE A FUNDING IN FISCAL YEAR 05/06 & 06/07
Appendix D: Maps
adolescent_sbhc.wor
School Address City
Oakland TechniClinic. 4351 Broadway St Oakland
James Logan Health Center 1800 H St Union City
Berkeley High Health Center 2223 M. L. King Jr Dr Berkeley
Tri-High Health Services 2201 Encinal Ave Alameda
Fremont High Tiger Clinic 4610 Foothill Blvd Oakland
San Lorenzo High Health Ctr 50 E. Lewelling Blvd San Lorenzo
Roosevelt Health Center. 1926 19th Ave Oakland
Tennyson Health Center 27035 Whitman St Hayward
McClymonds Health Center 2607 Myrtle St Oakland
Youth Uprising Health Center 2249 88th Ave Oakland
Alameda Family Services SBHC 210 Central Ave Alameda
PLEASANTON
DUBLINSAN
LEANDRO
HAYWARD
LIVERMORE
ALAMEDA
OAKLAND
BERKELEY
CASTRO VALLEY
NEWARK
UNION
CITY
FREMONT
Axis Community Health
Axis Community Health
Native American Health Center
Over 60 Health Center East
Clinica Alta Vista
La Clinica Dental/Children's
San Antonio Neighborhood
La Clinica de la Raza
La Clinica Dental
Asian Health Services
Albert J Thomas Medical Clinic
Asian Health Dental Clinic
Over 60 Health Center
Asian Adult Medical services
LifeLong Medical Care DOC
West Oakland Health Center
LifeLong Dental Care Berkeley Women's Health Center
Berkeley Primary Care AccessWest Berkeley Family PracticeWilliam Byron Rumford Medical
Tiburcio Vasquez, Hayward
Tri City Health Center
Tri City Health Center
Tiburcio Vasquez Logan Health
Tiburcio Vasquez, Union City
July 8, 2008Prepared by: Alameda Co. Health Care Services Administration
West Oakland Health Council
Asian Health Services
La Clinica De La Raza
LifeLong Medical Care
Native American Health Center
Tiburcio Vasquez Health Center
Tri City Health Center
Axis Community Health
Adult Medical Services
Asian Health Services
Dental Clinic
275 14th Street, Oakland
818 Webster St., Oakland
345 9th St., Oakland
La Clinica de la Raza
Clinica Alta Vista
La Clinica Dental
San Antonio Neighborhood
La Clinica Dental/Children's Hosp
3451 E. 12th St., Oakland
1515 Fruitvale Ave., Oakland
3050 E. 16th St., Oakland
1030 E. 14th St., Oakland
757 E. 16th St., Oakland
Berkeley Primary Care
LifeLong Dental Care
Downtown Oakland Clinic
Over 60 Health Center East
Over 60 Health Center
W. Berkeley Family Practice
2001 Dwight Way, Berkeley
1860 Alcatraz Ave, Berkeley
616 16th St, Oakland
10700 MacArthur Blvd., Oakland
3260 Sacramento St., Berkeley
2031 Sixth St., Berkeley
Native American Health Ctr.3124 E. 14th St., Oakland
Tiburcio Vasquez Hayward
Tiburcio Vasquez Union City
22331 Mission Blvd., Hayward
33255 9th St., Union City
Tri City Health Center
Tri City Health Center
2299 Mowry Ave., Fremont
39500 Liberty St., Fremont
Axis Community Health
Axis Community Health
4361 Railroad Ave., Pleasanton
3311 Pacific Ave., Livermore
Albert J. Thomas Med. Clinic
West Oakland Health Center
William Byron Rumford Med Ctr
East Oakland Health Center
10615International Bl., Oakland
700 Adeline St., Oakland
2960 Sacramento St., Berkeley
7450 International Bl., Oakland
PRIMARY CARE COMMUNITY BASED
ORGANIZATION (CBO) CLINICS
RECEIVING MEASURE A FUNDING IN FISCAL YEAR 05/06 & 06/07
Bay Area Consortium for Quality Health Care
Berkeley Women's Health Ctr.2908 Ellsworth St., Berkeley
Community-based Organizations
Appendix D: Maps
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