Sonoma County health department’s tardy contracts continue to hinder providers
In late May, a Sonoma County Department of Health Services employee sent a letter to each member of the county’s Board of Supervisors. Among other charges leveled against DHS, the letter raised an issue that had not been publicly addressed before.
“Ms. Rivera has managed to build a 45 million dollar deficit in billing Medi-Cal/Medicare for DHS services,” wrote the staff member, who requested anonymity in a subsequent interview with The Press Democrat, citing fear of retribution by his employer.
“Community partners/contractors have not been paid (causing several to go out of business due to the financial hardship), and contracts and grants have not been executed or followed up on (causing great harm to the community by DHS’s inability to provide services).”
A half-dozen people affiliated with local nonprofits talked to The Press Democrat about the chronic DHS backlog in processing Medi-Cal expenses — fees subsidized by California’s public health insurance program and owed to behavioral health providers in the county. Most insisted on anonymity for fear of alienating public funding sources that allow them to operate.
Another half-dozen declined interviews on the subject.
Those who spoke described a cumbersome and unforgiving state bureaucracy, public spending gaps and staffing shortages that couldn’t be blamed on any one person. Most agreed the snags in Sonoma County long preceded Rivera.
But pretty much everyone who spoke to The Press Democrat for this story agreed on one vexing problem. The Sonoma County Department of Health Services has a history of failing to execute timely contracts for its behavioral health providers, often leading to a grim financial situation for health-focused nonprofits, and for the vulnerable populations they serve.
“You hate to have to ask, do we not feed this senior, or do we not provide housing services to this needy family?” said Elece Hempel, executive director of Petaluma People Services Center, which oversees dozens of human services programs. “Yes, we’ll get reimbursed for that. But when? And how? Unlike a for-profit business, I can’t just go out and make more widgets.
“My widgets are my guaranteed contracts I have with county or state government. Even if they’re just slow to pay, it creates a hardship.”
Petaluma People Services Center does not currently have any contracts with Sonoma County DHS, but it has in the past.
The consistent lags in processing contracts for behavioral health providers are not in dispute. Nor are the ramifications, which include budget imbalances that require the organizations to borrow from lenders, devote time to raising money or trim services. In fact, Rivera opened up about those things in an October interview with The Press Democrat, vowing to get the process on track.
“I’ve certainly had some difficult conversations with providers,” she said. “But necessary conversations. I don’t take it personally, because I know I’m not the source of what’s going on. But I know I can correct what’s been happening here, historically.”
When the board of supervisors removed Rivera’s “interim” tag and officially named her DHS director last February, they asked her to create an 18-month plan. She immediately identified partner contracts as a top priority.
“What’s the problem?” Rivera recalled thinking. “Is it staffing? Where are the bottlenecks? I didn’t have time do a deep analysis of when did this start. My concern was, OK, how can we stop this? What resources can I bring to bear to correct it?”
Sonoma County DHS does not offer hands-on health services to its residents. Instead, it relies on a network of providers. Those that provide medical diagnosis and treatment, such as hospitals, private doctors and Federally Qualified Health Centers, bill the state directly for Medi-Cal services rendered.
The situation is trickier for a smaller subset of community-based organizations that offer behavioral health services — a broad category that includes mental health counseling, addiction treatment and homeless services.
Those providers receive money from the county, and are essentially subcontractors. They offer free or reduced-fee services to Medi-Cal patients, and submit payment requests to DHS. The department pays its contracted providers, and in turn files reimbursement requests with the California Department of Health Services.
The state requires strict adherence. After a 2020-21 compliance review, the Department of Health Services initiated a “corrective action plan” for Sonoma County, citing the absence of a process to review and verify the accuracy of submitted Medi-Cal claims, and a failure to document annual audits of providers.
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