SUBJECT
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SHERIFF - REQUEST FOR AUTHORIZATION TO ISSUE A COMPETITIVE SOLICITATION FOR DENTAL SERVICES AT DETENTION FACILITIES (DISTRICTS: ALL)
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OVERVIEW
The San Diego Sheriff's Office (Sheriff's Office) provides comprehensive health care services, including dental care, to incarcerated persons in custody at the Sheriff’s detention facilities as required by Title 15 of the California Code of Regulations. As the incarcerated population needs have changed in complexity, the current dental service model is no longer sufficient to meet demand for timely, restorative, and specialty care. In particular, the absence of on-site or off-site contracted endodontic services, the specialty of treating conditions such as tooth pain, pulp inflammation and infections caused deep decay, trauma or repeated dental procedures, has resulted in preventable dental emergencies, tooth loss, and increased off-site transports that impact facility operations and patient outcomes. In recent years, the Sheriff’s Office has enhanced its level of medical and mental health care services to meet the dynamic needs of the populations served and legal obligations, therefore overall medical services have increased to address complex diagnoses and the fundamental shift of health service delivery from ad-hoc acute care services in an ambulatory setting to comprehensive, preventive, and chronic care services in a structured institutional environment.
To address these trends, the Sheriff's Office is seeking to expand the existing onsite patient access to dental health care and to enhance care by including specialty endodontic care. This enhancement would optimize oral health outcomes for the patient population by providing access to tooth restorative services for higher acuity cases and help to preserve natural teeth. The endodontic specialists will be made available to the patient population through contracted providers on-site and through specialty service referrals to providers in the community for more complex cases. Providing these services will improve the overall oral health and well-being of the patient population. The proposed solicitation would expand access to on-site dental care, add specialty endodontic treatment for higher‑acuity cases, and strengthen the overall continuum of oral health services available to individuals in custody. These improvements support better health outcomes, reduce operational and legal risk, and align with Medi-Cal reimbursement opportunities under CalAIM for eligible individuals.
Today's action requests the Board of Supervisors to authorize a competitive solicitation for dental services for the incarcerated population in the Sheriff’s Office's custody for one year, with four option years, and a six-month extension if needed and to amend the contract as required to reflect changes to services and funding allocations, subject to the approval of the Sheriff's Office.
RECOMMENDATION
SHERIFF
1. In accordance with Section 401, Article XXIII of the County Administrative Code, authorize the Director of the Department of Purchasing and Contracting to issue a competitive solicitation for dental services for the incarcerated population in the Sheriff’s Office's custody, and upon successful negotiations and determination of a fair and reasonable price, award a contract for an initial term of one year, with four one-year option periods, and an additional six-month extension, if needed, and to amend the contract as needed to reflect changes to service requirements and funding, subject to approval of the San Diego Sheriff's Office.
EQUITY IMPACT STATEMENT
The U.S. Centers for Disease Control and Prevention (CDC) Healthy People 2030 define a health disparity as a “particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage.” Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health care based on their racial or ethnic group and other characteristics historically linked to discrimination or exclusion. This request for a Medi-Cal-enrolled dental service provider builds greater health equity for our incarcerated population. It gives incarcerated people access to high quality and affordable dental services while in custody, providing them with more adequate medical care. The San Diego Sheriff's Office is dedicated to advancing health equity outcomes for incarcerated persons and having an on-site dental provider allows timely and effective clinical engagement.
SUSTAINABILITY IMPACT STATEMENT
Most individuals in the carceral environment have experienced, or continue to experience, notable health disparities. Having continued onsite dental care and an on-site endodontic provider supports the County of San Diego's Sustainability Goal to provide just and equitable access. Advancing health care equity outcomes mean ensuring that everyone has a fair and just opportunity to be as healthy as possible and has ready access to medical and behavioral care with proximity to clinical services.
FISCAL IMPACT
Funds for this request are included in the Fiscal Year 2026‑27 CAO Recommended Operational Plan for the San Diego Sheriff’s Office (Sheriff’s Office). If approved, the estimated annual cost for the initial year of the contract is $3,835,207 in Fiscal Year 2026-27. The funding source is General Purpose Revenue. Funds for the option year costs will be included in future years Operational Plans for the Sheriff’s Office if the option years are exercised. There will be no change in net General Fund costs and no additional staff years.
BUSINESS IMPACT STATEMENT
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ADVISORY BOARD STATEMENT
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BACKGROUND
The San Diego Sheriff’s Office (Sheriff's Office) operates seven jail facilities across the County of San Diego (County) with an average daily incarcerated persons population of approximately 4,200. As a result of Assembly Bill 109 enacted in 2011, California county jails now house large numbers of incarcerated people previously detained in the State’s prisons. Assembly Bill 109 was enacted to address overcrowding in State prisons, shifting the responsibility for housing certain lower-level felony offenders to county jails, significantly making increased demands on county jail facilities, staffing, and medical services. There is no limit to the length of the sentence of an incarcerated person in local custody. This has required a transition in the focus of incarcerated people’s health service delivery to address chronic disease, preventive care, disease management, and an aging population. The County’s jail system now provides long-term health care that requires medical specialization, integrated services, and a holistic approach to the incarcerated person’s well-being. This shift has required the County’s correctional health system to move from primarily episodic, urgent care to comprehensive, preventive, and specialty services.
Title 15 of the California Code of Regulations establishes minimum standards for the delivery of medical, mental health, and dental services in county detention facilities, requiring prompt access to clinically appropriate care. Under Title 15 of the California Code of Regulations, County detention facilities must provide emergency and medically necessary dental care under the supervision of a California licensed dentist and must ensure that incarcerated individuals have timely access to dental treatment consistent with their clinical needs. Meeting this requirement depends not only on policy but on adequate onsite staffing, availability of clinical and diagnostic equipment, and the ability to deliver restorative and specialty care within clinically appropriate timeframes.
On August 4, 2020 (1), the Board of Supervisors (Board) approved the Sheriff’s request to issue a competitive solicitation for health care services. On April 26, 2022, the County awarded a contract for consolidated health care delivery. and services began on June 1, 2022. The contract for comprehensive health care services includes provisions for dental services. Although dental services are included in the broader health care contract, the current structure does not provide the level of specialty care now required to meet patient acuity or operational demand. When the consolidated health care contract was developed, the dental scope was intentionally structured to meet the requirements of Title 15, which mandate timely emergency and medically necessary care under the supervision of a licensed dentist. At that time, most of the demand was for basic services, and specialty restorative needs were relatively limited, making a basic‑care model appropriate and consistent with operational expectations.
In the years since, however, changing population characteristics and updated guidance from national correctional health standards have demonstrated that the existing model cannot sustainably meet the volume of routine and restorative care now required. Specifically, recent guidance from the National Commission on Correctional Health Care (NCCHC) recommends a benchmark ratio of one dentist per 1,000 incarcerated individuals. Applying this standard to the Sheriff’s daily population indicates a requirement for four to five full‑time dentists, supported by dental hygienists and assistants. Transitioning to a dedicated dental contract will allow the Sheriff’s Office to align service delivery with these nationally recognized standards and ensure timely access to preventive and specialty dental care and the shift reflects the evolution of clinical and operational needs, not a failure of the prior contract design. The dental scope under the consolidated health care contract was limited to basic services such as exams, cleanings, simple restorations, and extractions. Specialty restorative services, specifically endodontic treatment, were not included because the clinical acuity and volume of such cases at that time did not indicate the level of need now experienced. As the population has become more medically complex, the demand for specialty dental care has substantially increased, resulting in cases that exceed the capabilities of the existing contract structure. The dental scope will be terminated by mutual agreement between the Sheriff’s Office and the current contractor, coordinated to avoid any disruption in care.
The Sheriff’s Office intends to fully discontinue all dental services under the consolidated health care delivery contract and transition all dental care, including basic, routine, urgent, and specialty services, to the vendor selected through the new competitive solicitation. This transition will unify all levels of dental care under a single provider and eliminate fragmentation between basic and specialty services.
The Sheriff’s Office previously budgeted for only basic dental services under the consolidated contract, consistent with the limited scope of the agreement. Specialty services such as endodontics were not anticipated at the time because the population’s clinical acuity and volume of higher‑complexity cases were significantly lower. As specialty needs have escalated over the past four years, the Sheriff’s Office can no longer meet patient demand or Title 15 expectations under the existing cost structure. The Sheriff’s Office is projected to pay $1,534,083 for dental services in Fiscal Year 2026-2027 under the existing consolidated contract. The proposed dedicated dental contract has an estimated cost of $3,835,207 for Fiscal Year 2026-2027. The difference, approximately $2,301,124, reflects the increased services capacity needed to meet Title 15 and NCCHC expectations. This increase was incorporated into the Fiscal Year 2026-2027 CAO Recommended Operational Plan. No additional General Fund appropriation is being requested.
On January 26, 2023, California received federal approval to offer Medicaid services to Medi-Cal eligible youths and adults in correctional facilities, to include county jails, for up to 90 days prior to release, also known as the Justice-Involved Reentry Initiative or Medi-Cal Transformation. The Medi-Cal Transformation (CalAIM) focuses on integrating care and adding community supports but maintains core services. Dental services are a core component of the CalAIM initiative. Under CalAIM’s justice‑involved benefits, the County may claim reimbursement for eligible services provided within 90 days prior to release, including dental care. Because reimbursement depends on individual eligibility and timing of release, precise dollar estimates by discipline are not reliable at this stage. The Sheriff’s Office will track eligibility share and claims activity and report results as the program matures. Precise reimbursement projections are not feasible until program operations mature because claims depend on individual Medi‑Cal enrollment and timing of release, current estimates indicate that up to 40 percent of the incarcerated population may qualify for justice‑involved Medi‑Cal coverage.
Dental care remains one of the most frequently needed medical services in the detention setting, and unmet dental needs can rapidly escalate into emergencies requiring hospitalization, off-site transport, or extraction. Currently, available services are limited to basic dental care, and the absence of specialty endodontic treatment, the specialty of treating conditions such as tooth pain, pulp inflammation and infections caused deep decay, trauma or repeated dental procedures, prevents clinicians from providing tooth‑saving procedures for individuals with advanced dental conditions. As a result, patients often experience avoidable pain, diminished oral health outcomes, and an increased likelihood of extractions as the only viable treatment option. These gaps also place additional strain on operations, including increased off-site transports, higher security staffing needs, and elevated clinical risk.
Today’s action requests the Board to authorize a competitive solicitation for dental services for the incarcerated population in the Sheriff’s Office's custody. If approved, the solicitation will result in awarding a contract for an initial term of one year, with four option years, and a six-month extension. A five-year contract term will enhance both operational and budgetary stability, aligning with the County’s long-term strategic planning. This continuity is essential to effectively support and sustain the goals of the Medi-Cal Transformation Initiative.
LINKAGE TO THE COUNTY OF SAN DIEGO STRATEGIC PLAN
Today’s proposed action to authorize the competitive procurement of dental services supports the Community Initiative of the County of San Diego 2026-2031 Strategic Plan and aligns with the objective by improving the quality of life of incarcerated individuals by providing services that increase their well-being.
Respectfully submitted,
KELLY A. MARTINEZ
Sheriff
ATTACHMENT
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