Adopt Memorandum of Understanding (MOU) with the Golden State Finance Authority (GSFA) in the amount of $88,864 for participation in the regional Jail Medical Care Feasibility Study. (General fund impact) (Webb/Bryan)

Adopt Memorandum of Understanding (MOU) with the Golden State Finance Authority (GSFA) in the amount of $88,864 for participation in the regional Jail Medical Care Feasibility Study.

Counties across California are experiencing growing challenges in meeting state-mandated medical care requirements within their jail systems. Rising service costs, expanding regulatory expectations, persistent workforce shortages, and increased demand for both physical and behavioral health services are placing significant pressure on county operations and budgets. These impacts are especially pronounced in rural and mid-sized counties, where limited scale, geographic constraints, and workforce availability create additional barriers to service delivery. Contract costs for jail medical services have increased substantially from one contract cycle to the next. With a limited number of qualified service partners, counties also face concerns about continuity of care should a provider leave the market. In addition, counties are experiencing heightened litigation and liability exposure related to in-custody medical care. In discussions with regional working groups, PRISM, a member-directed risk management joint powers authority, noted recent cases involving in-custody deaths and medical care claims that resulted in multimillion-dollar settlement demands.

In response to these shared challenges, the Rural County Representatives of California (RCRC), in partnership with PRISM, convened five regional task forces in early 2025 composed of County Executive and Administrative Officers (CEOs and CAOs). The purpose of these task forces was to explore long-term strategies for improving the delivery, quality, cost-effectiveness, and risk management of jail medical care, including the potential for regional collaboration.

Following a series of working group meetings with each region, the Golden State Finance Authority (GSFA), RCRC’s affiliated public agency, issued Request for Proposals (RFP No. 2025-GSFA-001) on October 13, 2025. (See Attachment A.) The purpose of the RFP was to procure a qualified consultant, or team of consultants, to conduct a feasibility study evaluating alternative models for jail medical care delivery across five defined regions of California, encompassing a total of 26 participating counties (See Attachment B for a map of participating counties within each region). The feasibility study is intended to support counties in assessing regional collaboration opportunities, cost-effective service delivery approaches, quality-of-care considerations, and compliance with applicable state and national standards (see Attachment C for list of deliverables to be completed under the contract).

The RFP submission period closed on December 12, 2025, resulting in two qualifying proposals. GSFA conducted an internal evaluation process that included technical scoring and consultation with each CAO-led regional working group in early January 2026. Through this process, regional working groups identified preferred consultants to support the feasibility study within their respective regions. The firm selected is NCCHC Resources.

This staff report is provided to support the Board’s consideration of the attached MOU (Attachment D) related to participation in the Jail Medical Care Feasibility Study. Through the proposed MOU, the county would partner with the GSFA to fund and participate in a coordinated, data-driven evaluation of long-term jail medical care alternative alongside similarly situated counties. Yolo County is included in the Sac/Sierra Region. Attachment E provides a breakdown of the counties and the respective cost allocation. Under the anticipated structure, GSFA will serve as the contracting entity and program facilitator, convene coordination meetings between county staff and the selected consultant, and act as the fiscal intermediary responsible for processing and paying consultant invoices using funds contributed by participating counties. The feasibility study will be performed exclusively by the selected consultant, and the MOU will become effective only upon execution by all participating counties within the region.

Rural County Representatives of California (RCRC)
County Counsel