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111621-06.1 Staff Measure X Funding Recommendations ppt
fro, 4 1;11 ley'' I 0111,4 0'11 .60 r'lilt! Af Measure X Funding Recommendations November 16, 2021 Recommendations 1. Acknowledge the important work of the Measure X Community Advisory Board, which followed a principled, rigorous, inclusive, and equitable process to develop funding recommendations. 2. Establish a Measure X sales tax reserve policy of 25% ($26 million/ approximately). 3. Review Measure X sales tax projections. 4. Establish an on-going Measure X funding cycle of 3-5 years. 5. Adopt an expenditure plan for one-time, first year, and on-going allocations. 6. Establish Department 0013 in the Finance System to track receipt and disbursement of Measure X general purpose revenues, 7. Adopt attached appropriations adjustments, and 8. Direct staff on next steps. Reserve Recommendation • Due to the seasonal fluctuation of sales tax revenues, an adequate fund balance is essential to mitigating adverse impacts to on-going programs from short-term or long-term reductions in revenue. • Therefore, it is recommended that a Measure X reserve be established. • The Community Corrections Partnership (CCP) provides a model for establishing a reserve. The CCP is responsible for the development of the County's AB109 Plan that advises the Board of Supervisors on specific programming needed to implement the provisions of the 2011 Public Safety Realignment legislation. Historically, the CCP has aimed to have an on-going budget that was fully funded by the Community Corrections base annual revenue. To ensure that sufficient fund balance reserves are maintained, the CCP established a fund balance reserve policy to maintain a minimum fund balance equal to 50% of the on-going Community Corrections budget. • Balancing strong financial policy with community needs, it is recommended that a funding reserve of 25% be established for Measure X. A reserve of approximately $26 million will support three months of on-going operations should sales tax revenues decline drastically. Revenue and Allocation Projections Net Revenues Available for Board Action FY 2020-21 Actual Revenues $27,471,000 FY 2021-2022 Projected Revenues $104,000,000 FY 2022-2023 Projected Revenues $107,000,000 Total $238,471,000 Reserved Monies $26,000,000 One -Time Allocation Available $105,471,000 $212,471,000 Initial On -Going Allocation $107,000,000 Total $238,471,000 On -Going Allocations • The Measure X Advisory Board identified on-going needs in the community, which require on-going revenues for a specified period. • In order to provide sufficient time to establish programs that will positively impact the community and produce measurable outcomes, it is recommended that on-going funding be allocated for an initial three -to -five-year period. • Due to the timing of these recommendations (mid-November) and normal timing associated with starting new/expanded programs including planning, hiring and purchasing, it is further recommended that the initial on-going funding cycle be April 1, 2022 through June 30, 2023. • Future cycles will be included in the County's annual budget and will be based upon the County's fiscal year of July 1 through June 30. Expenditure Plan • The expenditure plan included in this report includes one-time allocations (available for distribution immediately), first cycle funding allocations of fifteen months (available April 1, 2022 through June 30, 2023), and future year on-going allocations • Individual County departments were identified to act as the host department for programs. • Thirty-one program areas identified by the Measure X Community Advisory Board are recommended for funding at this time. • It is anticipated that County departments will contract with community-based organizations to provide some of these services. • The County Administrator is recommending that departments be given additional consideration when requests are made for approval of RFP waiver for the first funding year. Five Goals othe Measure X C Advisory B The programs included in the expenditure plan identified below are categorized by the five goals of the Measure X Community Advisory Board. As noted by the Advisory Board, many programs fall into multiple goal areas: • Goal #1: Mental Well -Being: We strive to be a community that supports the mental and behavioral health and well-being of all residents through prevention, crisis response services, intersectional supports, and innovative cross -sector approaches. • Goal #2: Equity in Action: We strive to be a community that prioritizes equity and removes structural barriers that cause inequities and poverty, so that all residents can thrive. • Goal #3: Healthy Communities: We strive to be a community in which all residents have access to affordable, timely, culturally -responsive healthcare; adequate housing; high-quality childcare; and nutritious food, all of which have become more urgent as we address the ravages of the pandemic. • Goal #4: Intergenerational Thriving: We strive to be a community that intentionally strengthens and provides support for all residents and for family members of all generations, including children, youth, and older adults. • Goal #5: Welcoming & Safe Community: We strive to be a community where all residents feel safe and welcome and receive emergency help when they need it. 4/1/2022 through On -Going Program Area One -Time 6/30/2023 Total Allocation FY 2023-2024 Goal #1: Mental Well Being: CCRMC Psychiatric Emergency Services - 3,000 square feet Expansion $ 5,000,000 A3 Contra Costa Community Crisis Initiative $ 5,000,000 $ EPSDT Leverage Fund for Children's Mental Health Services $ 3,250,000 San Ramon Valley FPD Behavioral Health Crisis Response Pilot Program $ 740,200 $ 5,000,000 $ 5,000,000 $ 20,000,000 $ 3,250,000 $ 740,200 Goal #2: Equity in Action: Innovation Fund (Pilots and Innovative Projects) $ 2,000,000 $ 2,000,000 Racial Equity and Social Justice $ - $ 600,000 $ 600,000 $ 1,200,000 Arts and Culture Programs $ - $ 250,000 $ 250,000 $ 250,000 Language Access Equity for Measure X Meetings $ 50,000 $ 25,000 $ 75,000 $ 25,000 Measure X Needs Assessment Report Writer $ 20,000 $ 20,000 Goal #3: Healthy Communities: Contra Costa Regional Medical Center $ 40,000,000 $ 40,000,000 $ 40,000,000 CCRMC Medical Clinic and Office Complex - 40,000 square feet Expansion $ 30,000,000 $ 30,000,000 New Public Health Lab - 15,000 square feet $ 25,000,000 $ 25,000,000 CCRMC Parking Structure - 325 spaces $ 15,000,000 $ 15,000,000 CCRMC Interventional Radiology - 5,000 square feet Suite $ 5,000,000 $ 5,000,000 Local Housing Trust Fund (Including Funding for Homeless Housing/Services) $ 10,000,000 $ 10,000,000 $ 12,000,000 Permanent Supportive Housing (Net of Match) $ 5,200,000 $ 5,200,000 Contra Costa CARES - Expanded/Comprehensive Healthcare for Uninsured $ - $ $ - $ 750,000 Goal #4: Intergenerational Thriving: County Youth Centers - East and Central County $ 10,000,000 $ 1,750,000 $ 11,750,000 $ 3,500,000 Accessible Transportation Strategic Plan Implementation $ - $ 1,400,000 $ 1,400,000 $ 1,400,000 Master Plan for Aging/Local Community Based Aging Services $ 250,000 $ 1,000,000 $ 1,250,000 $ 2,000,000 Goal #5: Welcoming & Safe Community: East County Fire — Build/Reopen and Staff Fire Stations (via annexation) $ 17,200,000 $ 17,200,000 $ 3,500,000 Contra Costa County Fire - Build/Reopen and Staff Fire Stations $ 1,600,000 $ 3,500,000 $ 5,100,000 $ 3,500,000 Fire/Wildland Mitigation/Fuel Reduction $ - $ 4,500,000 $ 4,500,000 $ 4,500,000 Pinole Fire —Increase Service (via contract or annexation) $ 2,000,000 $ 2,000,000 $ 2,000,000 Unincorporated Patrol - Decreased Response Times $ 360,000 $ 6,000,000 $ 6,360,000 $ 6,000,000 Body Worn and In -Car Cameras - Sworn Staff $ 720,000 $ 1,841,000 $ 2,561,000 $ 1,841,000 Climate Sustainability -Sustainability Trust Public Works Projects $ - $ 2,500,000 $ 2,500,000 $ 2,500,000 Climate Equity and Resilience Investment in Conservation and Development $ 500,000 $ 500,000 $ 500,000 Community Based Restorative Justice $ 2,000,000 $ 2,000,000 Illegal Dumping Initiative $ 600,000 $ 600,000 $ 600,000 Sales Tax Consulting Administrative Expense $ $ 265,000 $ 265,000 $ 200,000 Totals $ 128,390,200 $ 76,731,000 $ 205,121,200 $ 106,266,000 Goal #1: Mental Well -Being Program Area One -Time 4/1/2022 through On -Going 6/30/2023 Total Allocation FY 2023-2024 Goal #1: Mental Well Being: CCRMC Psychiatric Emergency Services - 3,000 square feet Expansion A3 Contra Costa Community Crisis Initiative EPSDT Leverage Fund for Children's Mental Health Services San Ramon Valley FPD Behavioral Health Crisis Response Pilot Program 5,000,000 5,000,000 $ 3,250,000 740,200 5,000,000 5,000,000 $ 20, 000, 000 3,250,000 740,200 T ‘P,=C-C+3AEP_A1 ARA" GRIT. AJA II NNW _ x _N{ n-1 1112 AV5 u� w 8SEE it /07/74 via zo- -i VICE EN TRY RESDENTLAL ZONE C $TREE T 553 ME ENTRYHiGHSCHOCL • I Contra Costa Regional Medical Center Psychiatric Emergency Room Expansion and Modernization for Adults • Dramatic increase in clinical census from 7,800 patients to 10,500 patients annually over the last decade is driving the need for additional space and a different type of treatment environment. • The dormitory style PES unit does not provide the needed privacy and quiet environment psychiatric patients require for recovery and crisis stabilization. • The COVID pandemic has raised awareness that a modern physical space is needed to address the latest infection control practices. • As the county's only psychiatric hold designated intake unit, overcrowding has increasingly created concerns about safety and timely access. • Due to countywide increases in psychiatric morbidity and insufficient community resources a plan for expansion of the CCRMC PES unit has been proposed to reduce overcrowding and increase therapeutic space. • PES Expansion and Remodel: 3,000 square feet additional space. $5,000,000 estimated cost. CONTRA COSTA por anyone anywhere anytime A3 Contra Costa Community Crisis Initiative • Planning process started in November 2020 led by Contra Costa Health Services in collaboration with cities across the county and continued through July 2021 with 3 rapid improvement event weeks • Planning process involved many partners • People with lived experience • Family members • Law enforcement • Emergency medical services • Community-based organizations • County staff • Resulted in a vision for the future and a model for a comprehensive crisis response based on best practices and community input and experience • Launched the Miles Hall Community Crisis Hub call center pilot in August 2021 with existing staff taking calls from residents in crisis and dispatching existing resources Behavioral health issues increasingly recognized cis a major area of need 1 in 5 adults issues experiencing Third most 10,000+ involuntary behavioral health common EMS call psychiatric holds CONTRA COSTA HEALTH SERVICES 11 [ crisis center 1 Anyone in Contra Costa County can access timely and appropriate behavioral health crisis service Anywhere, Anytime. Community Crisis Initiative —one time CONTRA COSTA A Need for Help Someone to Talk To Someone to Respond A Place to Co CRISIS CALL n+.emevaf. ra Y. iN W1y. 211, liy M1aIA pr e l MILES HALL Community Crisis Hub Level 1 Teams Level 2 Teams Level 3 Teams Ilospkal 911 Firefighters Peer Respite Paramedics Police Sahering Center 1 Other Destination • One -Time Allocation for Infrastructure: $5 Million • Excludes costs for staffing of Miles Hall Crisis Hub and mobile response teams • Miles Hall Crisis Hub Facility • Renovation • Upgrades • Furnishings • Dispatch System Technology • System purchase • Hardware installation • Configuration & testing • Electronic Health Record (EHR) Integration • Configuration support • Maintenance including billing and revenue tracking CONTRA COSTA HEALTH SERVICES 12 CONTRA COSTA anyone anywhere anytime Community Crisis Initiative —Ongoing Support • On -Going Allocation for Staffing and Expanded Services: $20 Million • Crisis Hub Staffing — Mental Health Clinicians, Program Managers, Peer Support Workers • Mobile Response Teams to respond across the County • Level 1 Response Team - Peer Support/EMT • Level 2 Response Team - Peer Support, Clinician • Level 3 Response Team - Peer Support, Clinician, Law Enforcement • Vehicles and radios for the Mobile Response Teams • Alternative destinations - crisis intervention or restoration centers • Regional Deployment Centers — Locations to house regional teams that would support response times of 20 minute or less • Excludes costs for potential expanded regionalized crisis residential beds & respite services CONTRA COSTA HEALTH SERVICES Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Leverage Fund • One -Time Allocation: $3.25 million • Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Revolving Fund: • Will use funding from Measure X in conjunction with the 2011 Realignment Growth funds to secure Federal matching dollars • Will provide $6,500,000 in funding for the EPSDT Community Based Providers (CBOs) • Will provide the CBOs with up to a 10% rate and contract increase effective July 1, 2022 • The fund will be replenished on an annual basis from State Realignment Funds MENTAL HEALTH AWARENESS PUBLIC SAFETY FOR MENTAL HEALTH 2021 SRVFPD PILOT PROJECT GOALS A Fire/Emergency Medical Services first approach, while Law Enforcement stages. Partnership between Fire/Emergency Medical Services and Law Enforcement through the implementation of a specialized mental health and tactical training education plan. Implement early assessment and/or de-escalation techniques through the identification of low-risk, nonviolent responses. Reduce avoidable law enforcement engagement, while serving as a complimentary support system to County Mental Health Services. Support public service by improving care and advocacy for community members suffering from a mental health crisis. One -Time allocation of $740,200, future years costs covered by the SRVFPD u Goal #2: Equity in Action Program Area One -Time 4/1/2022 through On -Going 6/30/2023 Total Allocation FY 2023-2024 Goal #2: Equity in Action: Innovation Fund (Pilots and Innovative Projects) $ 2,000,000 $ 2,000,000 Racial Equity and Social Justice $ - $ 600,000 $ 600,000 $ 1,200,000 Arts and Culture Programs $ - $ 250,000 $ 250,000 $ 250,000 Language Access Equity for Measure X Meetings $ 50,000 $ 25,000 $ 75,000 $ 25,000 Measure X Needs Assessment Report Writer $ 20,000 $ 20,000 Innovation Fund (Pilots and Innovative Projects) • Establish an Innovation Fund to provide funding for pilot programs and innovative projects • Guidelines/policies for the fund have not been developed. • It is anticipated that the funding would be available to County departments, cities, and community-based organizations in response to local service needs. • The funding would be prioritized to community -embraced and community-based programs and services. • Minimally the funds would be used to support the Measure X funding goal of Equity in Action (Goal #2). • Significant work will be required to develop funding guidelines. Once developed, it is recommended that the Innovation Fund guidelines be reviewed in a future Finance Committee meeting prior to issuing requests for proposals. • Recommendation is to fund a one-time allocation of $2,000,000. Should the model produce positive measurable outcomes, additional funding will be recommended. The recommendation includes allocating these funds to the County Administrator's Office for development of funding guidelines and allocations. It is recommended that the Innovation Fund guidelines be reviewed in a future Finance Committee meeting prior to issuing requests for proposals. Racial Equity and Social Justice • Current Status • Racial and ethnic disparities in health outcomes, the criminal justice system, educational achievement, and social service metrics exist in Contra Costa County. • The Board of Supervisors authorized the establishment of an Office to better coordinate, strengthen and expand the County's existing work on equity & inclusion; create new opportunities to deepen the work; and allow the County to better partner with the community in prioritizing and implementing the work. • Community engagement and planning process underway since fall of 2020. • Contractor, Ceres, on -board for project management support of planning process (timeline development, coordination, data analysis, etc.). • Session currently in planning to review initial analysis of listening campaign, discuss gaps and next steps in inquiry and meaning -making. • Recommendation: Reserve $1,200,000 for on-going costs • Staffing and operational needs for the Office unknown at this time. Arts and Culture Programs • Current Status • Contra Costa County ranks last of all Bay Area counties in arts funding. • Contra Costa County has one part-time contractor. • Recommendation: An ongoing Measure X investment of $250,000 Arts Funding: • $100,000 for Support Staff: • Supplement existing funding for a full-time Managing Director and part-time Communication & Marketing employees. • $100,000 for District Public Art Program: • First public art program in Contra Costa County. • Addresses district public art program requests through a competitive application process. • $50,000 for New Programs: • Youth Advisor in each district: Expand equity and opportunity. • Arts Connection: Convene artists and art organizations for advocacy, opportunities, and data collection. • AIRS (Artist -in -Residency in the School) pilot program: Place teaching artists in CCC schools to work with students on art projects. Language Access Equity for Measure X Meetings • Current Status • The Board of Supervisors, at their May 18, 2021 meeting, approved a one-time allocation of $50,000 for contractual interpretation and translation services at MXCAB meetings. • MXCAB meetings benefited from two live Spanish interpreters and two live American Sign Language interpreters. • MXCAB meetings demonstrated community participation of both Spanish speaking and deaf or hard of hearing residents and/or community advocates. • MXCAB meetings through October resulted in approximate expenditures of $35,000* • Recommendation: An on-going Measure X investment of $25,000 Language Equity Funding: • $25,000 to fully fund interpretation services at future MXCAB meetings. *Cost includes initial document translation services, significant overtime hours, and a high volume of meetings that are not anticipated for a typical quarterly scheduled advisory body. Measure X Needs Assessment Report Writer • Current Status • The MXCAB bylaws include the body's responsibility to oversee an annual assessment of community needs, focusing primarily on the priority areas identified in the Needs Assessment. • The MXCAB did not prepare a formal Needs Assessment report and voted at their September 22, 2021 meeting to request from the Board a one-time $20,000 allocation of Measure X funding to hire a professional report writer to prepare a final needs assessment document for publication. • The MXCAB presented the priority areas to the Board of Supervisors at their October 12, 2021 meeting, after having conducted 12 meetings dedicated to presentations on the focused issues determined by the MXCAB. • At the October 12, 2021 Board of Supervisors meeting, members expressed an interest in also having a professional report writer take an unbiased look at the MXCAB proposed priorities. • Recommendation: A one-time Measure X investment of $20,000 Report Writer Funding: w • $20,000 to fully fund a professional needs assessment report writer in support of developing a detailed needs assessment that can serve as a future needs assessment tool. Goal #3: Healthy Communities Program Area Goal #3: Healthy Communities: Contra Costa Regional Medical Center CCRMC Medical Clinic and Office Complex - 40,000 square feet Expansion New Public Health Lab - 15,000 square feet CCRMC Parking Structure - 325 spaces CCRMC Interventional Radiology - 5,000 square feet Suite One -Time $ 30, 000, 000 $ 25, 000, 000 $ 15, 000, 000 $ 5,000,000 Local Housing Trust Fund (Including Funding for Homeless Housing/Services) Permanent Supportive Housing (Net of Match) Contra Costa CARES - Expanded/Comprehensive Healthcare for Uninsured $ 5,200,000 $ 4/1/2022 through 6/30/2023 $ 40, 000, 000 $ 10, 000, 000 $ Total Allocation $ 40, 000, 000 $ 30, 000, 000 $ 25, 000, 000 $ 15, 000, 000 $ 5,000,000 $ 10, 000, 000 $ 5,200,000 $ On -Going FY 2023-2024 $ 40, 000, 000 $ 12, 000, 000 $ 750,000 Contra Costa Regional Medical Center and Health Centers Contra Costa County is experiencing population growth, particularly in the Eastern region of our county, and significant health disparities in communities across the county. Many patients face food and housing insecurity and transportation issues as they struggle to earn living wages. These daily stressors and structural inequities have a negative impact on the overall population, and particularly in the population the Contra Costa Regional Medical Center and Health Centers serves where patients have a myriad of chronic health conditions. We recognize that collaborative and integrated care methods are required to help improve health outcomes in our population. • Approximately 50% of CCRMC/HC patients report two or more unmet basic needs such as access to food, housing and employment • 34% our patients have behavioral health needs requiring interventions • 57% of adults reported experiencing COVID-19 related adversity or trauma requiring resources and support • Nearly 50% of our patients utilize interpreter services in at least 45 different languages to communicate with their provider CONTRA COSTA HEALTH SERVICES Contra Costa Regional Medical Center and Health Centers Medi -Cal is jointly funded by states and the federal government. States can fund the non-federal share from a variety of sources. In California, the state relies heavily on public hospitals/counties to help fund the non- federal share for Medi -Cal. Public hospitals/counties provide billions of dollars of non- federal share each year, the vast majority of which fund supplemental payments to the public hospitals that are critical to the financial viability of these systems. The methods of financing the non-federal share by the public hospitals/counties fall into two categories: Intergovernmental Transfers (IGTs) or Certified Public Expenditures (CPEs). As a Designated Public Hospital (DPH), CCRMC must self -finance the vast majority of the Medi -Cal revenue streams utilizing IGTs or CPEs. Use of IGT/CPE process limits revenue growth because federal match does not keep up with the rising costs of care. Due to the historic disparity in Medi -Cal reimbursement rates as well as the structural funding mechanisms, CCRMC and HCs are chronically underfunded compared to private health systems. CONTRA COSTA HEALTH SERVICES Contra Costa Regional Medical Center and Health Centers As a result of the on-going financing challenges and the need to serve a more complex patient population, we are requesting on-going allocation: $40 million annually for operational stability • Annual unfunded component of projected cost for 2022/23 fiscal year and on-going is currently estimated at 5% of the operating budget - $40 million. • The current annual budgeted cost is $693 million • Approximately 90% of the cost is offset by revenue, i.e., Medi -Cal, Medicare, etc. • Remaining 10% is funded by County General Purpose revenues CONTRA COSTA HEALTH SERVICES Contra Costa Regional Medical Center Campus Needs • As the primary Medi -Cal hospital and clinic delivery system for Contra Costa County, the current facilities, which serve well over 142,000 patients (an increase of 540% over 20 years), are inadequate in size and scope to provide clinical and health services to patients • Proposed: • New Medical Clinic and Office Building Complex • New Parking Structure • New Interventional Radiology Suite • Expanded and Modernized Psychiatric Emergency Room (PES) — detailed in Goal #1 • Specialty and hospital services care for an additional 78,000 • Physical space on the Martinez campus is the biggest constraint • Added clinical space will improve: • Patient care and outcomes • Support Medi -Cal Waiver and supplemental funding requirements • Benefits of the proposed projects include • Improved staff and patient safety • Improved patient access to clinical care • Improved staff wellness • More equitable care services for our patient community • Modernization of infrastructure and care practices • Improved ability to scale services in the coming years CONTRA COSTA HEALTH SERVICES W1BiYVNCE t MINCE With?. C 2 1 K E E 1 2EK/ACE CIA IAA HICFI2C1-i0Or KEC IETD —- SONE 131210E.011lVr n _ 21dEE1 New Medical Clinic Office Building New Medical Clinic Office Complex • In the past 2 decades since construction, CCRMC/HC's empaneled patient assignment has grown over 540% to well over 142,000 individuals • An additional 78,000 lives seek specialty services, care coordination services, and hospital services within CCRMC/HCs • Our biggest constraint to managing and scaling services is the limited amount of physical space to provide direct patient care on the Martinez Campus. • Clinical space will improve patient care and outcomes; it will also support our Medi -Cal Waiver and supplemental funding requirements. • The Martinez campus master plan developed in 2009 called for construction of medical office buildings, additional parking, and other improvements to meet the demands of patient growth and increasing clinical care. • New Medical Clinic Office Complex: 40,000 square feet. $30,000,000 estimated cost. Current and Future Public Health Lab • One -Time Allocation: $25 million, estimated • Limitations of Existing Space — cannot leverage additional funding and new technologies • Electrical Capacity: Cannot pursue modernization and testing expansion • Spatial Capacity: Cannot bring on additional equipment and improve workflows or capacity in laboratory building • Unable to optimize COVID-19 variant testing (whole genome sequencing) without additional freezers to hold specimens • Build a new Public Health Lab capable of supporting community health including current and future pandemic response: • Demolish unusable space on the Contra Costa Regional Medical Center campus • Build 15,000 square foot new facility • Acquire the latest technologies and new equipment • Expand testing capabilities for all county residents • Be prepared for the next disease outbreak, health emergency and pandemic • Leverage additional State and federal opportunities to partner and fund cutting-edge methodologies CONTRA. COSTA HEALTH SERVICES Professional Ho 1 1' Rabies testing to determine need for immediate treatment Contra Costa Public Health Lab • Public Health Lab keeps our entire community healthy: • Broad -scale and individual testing for diseases and emerging health threats • Rapid outbreak testing and pandemic response • Monitoring of community recreational waters & food supplies • Training, information and support to all local hospital labs and health care providers • One of only two labs in California performing testing on meats, identifying potential causes for national and local outbreaks • The Public Health Lab provides services to support the entire county • These critical activities are unique to Public Health, typically done at a fraction of the cost of commercial labs — and faster Essential to COVID-19 Screening and Testing in Contra Costa: First to have access to supplies and methodology to perform COVID-19 testing in Contra Costa Infrastructure to support high-volume testing with a rapid turnaround time Partners with the State and CDC to get latest technology and supplies First to have ability to perform whole genome sequencing to identify variants in Contra Costa Continue to do approximately 25% of whole genome sequencing today in county CONTRA COSTA HEALTH SERVICES WIEWVW('E t 2E1INCE EY11lS A C 2 1 kS E E 1 2611MCE E1AIAA FNC1-I2C1400r KEC IETD LLIVr Y • E 21KEE1 - SONE LIE210E.0111Vr T • • m� 5 n [4,ffiff4a -� • A It r©l-E•H- • V SOME kSE2IDEN1Mr 11 New Parking Structure • The growth in patient volume has spotlighted the urgent need for additional parking for patients, visitors, and staff. • CCRMC has an average of 7,000 admissions, 34,000 Emergency Room visits, 10,000 PES visits, 4,700 outpatient surgeries and nearly 270,000 ambulatory visits per year. • Over 2,000 staff work at the Martinez Campus. • The resulting traffic and congestion have become a critical safety concern. • Patients with physical disabilities, small children, and cognitive difficulties often miss appointments because they are unable to find convenient and safe parking. Families coming to see loved ones and newborns in hospital often are limited to after-hours visits due to parking limitations. • New Parking Structure: 325 additional spots. $15,000,000 estimated cost. 30 Contra Costa Regional Medical Center New Interventional Radiology (IR) Suite • Over the last 2 decades small incision and non-surgical interventions to manage acute conditions with improved outcomes has become the standard of care. • Patients needing pain control, catheter or port placements, cancer medication infusions, abscess and infection drainage, and interventional diagnostics would benefit from these services being provided on demand at CCRMC. • Reduces need for patient transfer to surrounding hospitals with the associated delays in care due to coordination, transportation, and availability of services • New Interventional Radiology Suite: 5,000 square feet. $5,000,000 estimated cost. 31 Direct funding for the construction, acquisition, preservation, and rehabilitation of permanent affordable housing. Strategic use (lease, sale, or joint ventures) of County -owned surplus land and other underutilized land. Dedicated funds for homelessness prevention, such as legal services and rental assistance as well as homeless crisis response solutions including emergency and interim housing. Technical assistance to build capacity of non- profit housing developers and homeless service providers to expand to underserved geographic areas. Local Housing Trust Fund Ongoing funds for supportive services and active grant writing to leverage resources for affordable housing. $10M initial investment ($12M annually beginning 2023) Interagency collaboration among Contra Costa Housing Authority, Contra Costa Health Services, Department of Conservation and Development, and other potential partners will be key to2 implementation. _rr_ ering by Studio T Square Old Brookside Headstart Permanent Supportive Housing • One -Time Allocation: $5.2 million in Measure X funds could leverage $16.8M in State Homekey funding • Investment of Measure X dollars would: • Support the Board's commitment to reduce unsheltered homelessness by 75% over the next three years • Expand housing options available for persons experiencing homelessness • Build on the success of Homekey and leverage available state funding to achieve our housing goals. • Total 84 units of permanent, affordable housing with supportive services • 54 units of micro -housing for single adults with disabilities in San Pablo • 30 units of single -room occupancy in county -owned building in Richmond • Lack of affordable housing is a significant contributing factor to homelessness • Permanent solution to homelessness CONTRA COSTA HEALTH SERVICES Contra Costa CARES —Expanded/Comprehensive Healthcare for the Uninsured • In 2015 Contra Costa Health Plan (CCHP) established a pilot program, Contra Costa CARES, for the purpose of providing primary care services to adults not covered by the Affordable Care Act. • Contra Costa Health Plan coordinates the program for primary care services via three providers: La Clinica de la Raza, Lifelong, and Brighter Beginnings. The providers receive a capitated payment on a per member per month basis. • The Contra Costa CARES budget included a County General purpose revenue contribution of $250,000, CCHP revenue contribution of $500,000, and $750,000 in private hospital matching donations for a total annual program cost of $1,500,000. • The private hospital donations ended in fiscal year 2021/22. • The Health Services Department has contracted with Pacific Health Consulting to facilitate a process with stakeholders over the next several months to gather data and ideas about possible revisions to the CARES program to address the unmet needs of the remaining uninsured population. • Measure X funding in the amount of $750,000 is requested for fiscal year 2023/24. Goal #4: Intergenerational Thriving Program Area One -Time 4/1/2022 through On -Going 6/30/2023 Total Allocation FY 2023-2024 Goal #4: Intergenerational Thriving: County Youth Centers - East and Central County Accessible Transportation Strategic Plan Implementation Master Plan for Aging/Local Community Based Aging Services $ 10, 000, 000 $ 1,750,000 $ 11, 750, 000 $ 3,500,000 $ - $ 1,400,000 $ 1,400,000 $ 1,400,000 $ 250,000 $ 1,000,000 $ 1,250,000 $ 2,000,000 Youth Centers in East and Central County • Youth Centers for East and Central County are recommended for funding. • Given its focus on children and family services, Employment and Human Services Department (EHSD) would be the host agency to contract for the development and operations of the youth centers. • A significant amount of planning and logistics will be required to develop these centers. • The County Administrator's recommendation includes $5,000,000 for each of the two centers for infrastructure ($10 million total one-time), $1,750,000 for start-up costs through June 30, 2023, and on-going annual appropriations of $3,500,000 ($1.750 million each) for operations. • Approximately $5 million is estimated for each center for infrastructure and an annual budget of approximately $3.5 million, which will be supported at approximately 50% by donations, grants, etc. ACCESSIBLE TRANSPORTATION STRATEGIC (ATS) PLAN IMPLEMENTATION OLDER ADULTS, PERSONS WITH DISABILITIES, AND VETERANS ATS IMPLEMENTATION ACTIVITIES • • • Establishment of a Coordinating Entity. Responsible for short and long termTht implementation of accessible transportation strategies including the (I I L `identification of a new, ongoing funding source to support operations. � o 0 i • • 0ne Lail/One Click Operations Countywide, centralized phone and internet -resource for all modes of transportation serving target populations. $1,5‘ Assisting callers in making travel plans based on their abilities. • User -side Subsidies for low-income populations for whom existing fares are a barrier to access. • Expansion mmd Enhancement of One Seat Ride Pilot Progrart allowing passengers to travel throughout the county (and possibly outside the county) without having to transfer between paratransit vehicles. • Funding, On-going funding of $1.4 Million until stable funding is identified Master Plan for Aging/Local Implementation of Services Develop Contra Costa County MPA Loca Playbook - $250,00 one-time • Plan development • Stakeholder engagement • Awareness campaigns — anti -ageism, anti-ableism, ca regivi ng • Age -Friendly Communities engagement with Cities EMPLOYMENT & HUMAN SERVICES Build Provider Network Capacity & Fund Direct Services - $1 million on-going • Organizational development trainings • Innovative programs/demonstration projects • Modernizing current programs • Direct services support — transportation, family caregiver support, system navigation, legal services, workforce development, etc. Goal #5: Welcoming & Safe Community Program Area One -Time 4/1/2022 through On -Going 6/30/2023 Total Allocation FY 2023-2024 Goal #5: Welcoming & Safe Community: East County Fire —Build/Reopen and Staff Fire Stations (via annexation) $ 17,200,000 $ 17,200,000 $ 3,500,000 Contra Costa County Fire - Build/Reopen and Staff Fire Stations $ 1,600,000 $ 3,500,000 $ 5,100,000 $ 3,500,000 Fire/Wildland Mitigation/Fuel Reduction $ - $ 4,500,000 $ 4,500,000 $ 4,500,000 Pinole Fire — Increase Service (via contract or annexation) $ 2,000,000 $ 2,000,000 $ 2,000,000 Unincorporated Patrol - Decreased Response Times $ 360,000 $ 6,000,000 $ 6,360,000 $ 6,000,000 Body Worn and In -Car Cameras - Sworn Staff $ 720,000 $ 1,841,000 $ 2,561,000 $ 1,841,000 Climate Sustainability -Sustainability Trust Public Works Projects $ - $ 2,500,000 $ 2,500,000 $ 2,500,000 Climate Equity and Resilience Investment in Conservation and Development $ 500,000 $ 500,000 $ 500,000 Community Based Restorative Justice $ 2,000,000 $ 2,000,000 Illegal Dumping Initiative $ 600,000 $ 600,000 $ 600,000 Sales Tax Consulting Administrative Expense $ - $ 265,000 $ 265,000 $ 200,000 East Contra Costa Fire —Build/Reopen and Staff Fire Stations • Fire Station 51— $15 Million total cost (Empire Avenue, Brentwood) • One-time construction funds of $5 Million requested from Measure X • City of Brentwood has already committed $7 Million • Remaining funding from the Fire District and potential federal funding commitments • Ongoing Operational Costs • $3.5 Million beginning in FY 22/23 • Fire Station 54 — $12.2 Million total cost (First Street, Brentwood) • One-time funding requested • $1 Million for demolition of obsolete building (FY 21/22) • $10 Million for construction costs (FY 23/24) • $1.2 Million for apparatus (FY 22/23) • Ongoing Operational Costs • $3.5 Million beginning in FY 24/25 Contra Costa County Fire —Reopen Fire Stations • Con Fire has two remaining stations closed as a result of the great recession. • Fire Station 4 in unincorporated Walnut Creek is planned to be reopened with the district's FY 2022/23 budget and no use of Measure X funds • The reopening of the final Con Fire station requires Measure X support • Fire Station 12 in unincorporated Martinez would be the last closed Con Fire station. This area has a low call volume and is very close to Fire Station 14 in downtown Martinez. • The area served by the downtown Antioch fire station is underserved and impacted by very high call volume. • Planning and deployment software consistently recommends the next available resource to be staffed should be a second unit to serve downtown Antioch and the surrounding communities. • One-time funding is necessary to procure the apparatus • $1.6 Million one-time expenditure in FY 21/22 • On-going operational and staffing costs • $3.5 Million to provide fire, EMS, and rescue services to the underserved Antioch WiIdIand Fire Mitigation and Fuel Reduction • Extreme wildfire danger • Many communities are located in areas of increased wildfire risk • Lack of vegetation management and fuels reduction • Need for proactive year-round programs • Con Fire Hand Crew ($2.5 Million annually) • Funding to provide year-round staffing and equipment for fire mitigation and response as well as fuels reduction programs, hazard abatement, and vegetation clearance during non -peak fire season countywide. • Countywide Fuels Reduction Projects ($2.0 Million annually) • Funding to provide for contractors, consulting, specialized equipment rental for larger complex fuels reduction projects throughout very high and high fire hazard severity zones countywide. • The staffing of this hand crew and the fuel reduction funds will position the District to better take advantage of and leverage available state grant funds. Pinole Fire Department —Reopen Fire Station 74 • Fire Station 74 is the last remaining closed fire station in West County. • Funding of $2 Million annually to bridge the gap of available funds from the City to provide support for a contract for service by Con Fire to operate both fire stations within the City of Pinole — including reopening Fire Station 74. • The further functional and administrative consolidation of the Con Fire and Pinole service areas is important to provide consistent fire, EMS, and rescue services in what is now the "Battalion 7" model of three separate agencies serving a large population of West County. • Underserved communities would benefit from more stable staffing and levels of emergency services, fire prevention, fire investigation, and public education provided by Con Fire. Unincorporated Patrol —Decreased Response Times Efficient Service to Unincorporated Areas - $6,360,000 Live Move -Up -Module Dispatching for decreased patrol response - $500,000 One-time costs = $360,000 (equipment and set-up costs) Annual costs = $140,000 (program maintenance and support) Additional Patrol staffing generally for the most underserved communities of Montalvin Manor, Rodeo/Crockett, Saranap, Bay Point and Byron; additional service areas will decrease response times to all communities - $5,860,000 Deputy Sheriff for Community Patrol & Response = $298,800 x 16 = $4,780,800 Sergeant for Patrol Supervision & Accountability = $339,200 x 3 = $1,017,600 44 Body -Worn and In -Car Cameras —Sworn Staff Increased Transparency - $2,561,000 Body -worn and in -car cameras for all sworn officers and in all unincorporated patrol units. Professional Standards Division professional staff for administrative support. One-time costs = $720,000 (camera equipment and set-up costs) Annual costs = $322,000 $1,841,000 (equipment and personnel) $1,300,000 camera software, storage and support $219,000 Sheriff's Director (Program Manager) $161,000 Sheriff's Specialist (Records & PRA Oversight) x 2 = 45 Climate Sustainability - Sustainability Trust Public Works Projects Where we are INPUT Contra Costa County's Climate Action Plan How we are going to get there Climate Action Plan Implementation Sustainability Fund Projects • Clean Energy — Solar PV systems, Green Energy Supplier • Energy Efficiency — HVAC, Controls, Lighting Modernization • Electric Vehicles and Electric Vehicle Charging Infrastructure - County and Public facing at County facilities • Energy Storage — Lithium ion and flow battery systems for load management • Automated Demand Response systems tied to PG&E rate reduction program • Water Conservation — low flow faucets and toilets, turf conversions to drought tolerant landscaping for County facilities Sustainability Funds $2.5 million/year Focus on County facilities and operations Where we want to be OUTPUT Reduced Greenhouse Gas Emissions Improved Energy Efficiency Water Conservation Natural Resource Conservation Reduced Operating Costs OUTCOME Improved Environment Slow or reverse climate change Droughts, heat waves, sea level rise, degraded air quality, infectious disease and allergies, and extreme weather events OUTCOME Improved Public Health Reduced death, disease and injury from heat waves, floods, storms, and fires; increase food quality and security; and decreased morbidity and mortality— associated with air pollution Direct Link Climate Change and Public Health Climate Equity and Resilience Investment — Increased Sustainability Planning at the Department of Conservation and Development Funding: On-going funding of $500,000 Sea Level Rise Provide coordination and support County leadership on anticipating and responding to changing conditions. Community facing clean energy projects and programs Plan for community solar installations, community resilience centers, electric vehicle deployment, and related. Rethinking Contra Costa's Energy Economy Support Board of Supervisors in facilitating public input and building consensus on how we transition to new economic opportunities. Financing programs Develop and facilitate programs that help low- and moderate -income property owners invest in clean energy and energy efficiency. Carbon Sequestration Implement ongoing carbon sequestration feasibility study. Develop Countywide tree master plan. Collaborate on urban agriculture projects. 71 060 It�*Community Based Restorative Justice One-time allocation of- $2,000,000 Restorative justice emphasizes repairing the harm caused by delinquent or criminal behavior, acknowledging that these actions hurts everyone — victims, perpetrators and community. Request includes funding for: Training and technical assistance in restorative principles and practices Support staff to coordinate and oversee the training and technical assistance contract As the Probation Department begins to explore the development of a scope and design for the proposed multi -use youth campus, a consultant would be hired to advise on how to best create spaces that are aligned with restorative principles and practices. 48 Illegal Dumping Initiative The Illegal Dumping Initiative reduces illegally dumped waste in our communities by implementing 56 education, prevention, clean-up and enforcement strategies. It is jointly conducted by the Sheriff's Office, District Attorney's Office, Department of Public Works, Health Services Department, and Department of Conservation of Development. The strategies proposed to receive the Measure X funds initially are: Derelict Boat and RV Abatement Removal of derelict boats/RVs Capital Improvements Implement capital improvements to deter illegal dumping, such as street lighting or barricades r Surveillance Cameras Wireless high-definition surveillance cameras for illegal dumping hot spot monitoring and evidence collection Investigating and Prosecuting Illegal Dumping Crimes Dedicated illegal dumping deputies in the Sheriff's Office On-going funding of $600,000 49 Sales Tax Consulting Administrative Expense • Current Status • Contra Costa receives sales tax consulting services from HdL Companies, Inc. including: • providing quarterly reports of actual sales tax data, • conducting forward looking projections of sales tax receipts to assist with financial planning and • initiating appeals of incorrect sales tax reporting by the State, on behalf of the County, to ensure sales tax revenue is being correctly distributed to the County • Funding: $200,000 for on-going sales tax consulting services • This assumes costs of processing 1-2 large sales tax appeals on behalf of the County in a given year, which if successful, would recapture Measure X revenue that had been previously misdirected to other jurisdictions erroneously by the State. • The County pays HdL a commission of 15% on the amount of sales tax dollars recaptured due to a successful appeal. • For this reason, the commission paid to HdL is covered by the newly recaptured Measure X revenue generated from the appeal process with the remaining 85% available for local programming. Summary of Financial Impact The recommendations included in this report have the following financial impact: • A one-time cost of $128.39 million, • An April 1, 2022 through June 30, 2023 cost of $76.731 million, and • An on-going future fiscal years cost of $106.266 million. All of these recommendations will be funded with sales tax revenues generated through Measure X, which are general purpose revenues. • Staff requests that the Board provide additional direction regarding remaining funding totaling $7.350 million ($6.616 million one-time plus $734,000 on-going) in a future meeting. • Individual Board members requested follow-up information on the following six programs: Animal Services' dead animal pick-up, Childcare, Childhood Mental Health, Children with Disabilities, the Northern Waterfront Initiative, and Victim Assistance to Crime Victims. In the current funding cycle, Measure X for these programs (all on-going) is not feasible due to insufficient funding after addressing other MXCAB and Board of Supervisors' priorities. • Staff will work with the Advisory Board and department staff to develop measurable performance outcomes and provide the required annual report. It is anticipated an oversight report from the MXCAB would come to the Board after a twelve-month period.