SUBJECT
Title
AUTHORIZE ACCEPTANCE OF OLDER ADULT SERVICES REVENUE AGREEMENTS, MEMORANDUM OF UNDERSTANDING, AND GRANTS FOR FISCAL YEAR 2024-25, AND AUTHORIZE APPLICATION FOR FUTURE FUNDING OPPORTUNITIES FOR PROGRAMS SERVING OLDER ADULTS AND PERSONS WITH DISABILITIES (DISTRICTS: ALL)
Body
OVERVIEW
The County of San Diego (County) Health and Human Services Agency, Aging & Independence Services (AIS) serves as the region’s federally designated Area Agency on Aging (AAA) and administers programs focused on the safety and well-being of older adults and persons with disabilities. These services align with the Aging Roadmap, the County regional plan to ensure the region has programs and communities that equitably support the needs and leverage the contributions of all older adults in the county. On May 2, 2023 (4), the San Diego County Board of Supervisors (Board) approved Fiscal Year (FY) 2023-24 revenue agreements to fund various programs that support older adults and persons with disabilities, allowing them to remain safely in their homes and access needed community resources. Subsequently, on January 23, 2024 (2), the Board approved an additional FY 2023-24 revenue agreement to further support and expand these programs and services. These programs and services support the goals and objectives established in the AIS 2024-2028 Area Plan, approved by the Board on April 9, 2024 (6). Required by the Older Americans Act (OAA), the AIS Area Plan 2024-2028 details how AIS will utilize funds received through the OAA to provide services that meet the identified needs of older adults, persons with disabilities, and their caregivers throughout the county.
The California Department of Aging is transitioning from revenue agreements to a multi-year memorandum of understanding (MOU) for the Area Plan and Medicare Improvements for Patients and Providers Act Program and intends to transition to an MOU for the Health Insurance Counseling and Advocacy Program. The process for this transition is currently underway, however it is not yet known when the Health Insurance Counseling and Advocacy Program MOU will be finalized. This item requests the Board authorize acceptance of $33,284,979 of federal and State revenue agreements, MOU, and grants for FY 2024-25 to support these programs and services.
If approved, today’s action would authorize acceptance of funding through revenue agreements, MOU, and grants, and authorize Clerk of the Board to execute revenue agreements, MOU, and grants upon receipt, and authorize the Agency Director, Health and Human Services Agency to pursue future funding opportunities.
This action supports the County vision of a just, sustainable, and resilient future for all, specifically those communities and populations in San Diego County that have been historically left behind, as well as our ongoing commitment to the regional Live Well San Diego vision of healthy, safe and thriving communities. This will be accomplished by ensuring the County will continue to receive federal, State, and other funding to administer necessary programs and services for older adults, persons with disabilities, and their caregivers.
RECOMMENDATION(S)
CHIEF ADMINISTRATIVE OFFICER
1. Waive Board Policy B-29: Fees, Grants, Revenue Contracts - Department Responsibility for Full Cost Recovery, which requires full cost recovery of grants and revenue contracts.
2. Approve and authorize the Clerk of the Board to execute, upon receipt, the following revenue agreements, memorandum of understanding, and grants:
• California Department of Aging Agreements
o Older Californians Act Modernization (OM-2223-23 & NM-2324-23)
o Health Insurance Counseling and Advocacy Program (HI-2425-23)
o CalFresh Expansion and SNAP-Ed/CalFresh Healthy Living (CF-2223-23)
o Multipurpose Senior Services Program (MS-2425-07)
• California Department of Aging Memorandum of Understanding for Area Plan services, Health Insurance Counseling and Advocacy Program, and Medicare Improvements for Patients and Providers Act Programs (AAA-2425-23)
• San Diego Gas & Electric (Cool Zone program)
• Partners in Care Foundation
• Veterans Administration San Diego Healthcare System (Veteran Directed Home and Community Based Service Program)
• San Diego State University Research Foundation/Geriatric Workforce Enhancement Program
• University of California San Diego - Dementia Aware
3. Authorize the Clerk of the Board, subject to the approval of the Agency Director, Health and Human Services Agency or designee, to execute all required documents related to the revenue agreements, memorandum of understanding, and grants in Recommendation 2, including any extensions, amendments or revisions thereto that do not materially impact either the program or the funding level.
4. Authorize acceptance of the grant from the Corporation for National & Community Service for the Retired Senior and Volunteer Program.
5. Authorize the Agency Director, Health and Human Services Agency or designee, to apply for future funding opportunities that support programs serving older adults, persons with disabilities and their caregivers.
EQUITY IMPACT STATEMENT
There are approximately 710,000 San Diegans over the age of 60, and by 2030, that number is expected to grow to more than 850,000. Additionally, the population over the age of 85 in San Diego County is projected to diversify and grow faster than any other age group. The County of San Diego (County) Health and Human Services Agency, Aging & Independence Services (AIS) provides a wide array of services to meet the needs of this growing population and ensures the welfare of older adults, caregivers, and persons with disabilities. Community input regarding resources, services, and programs related to funding sources included in today’s request began in Fall 2023. AIS conducted 17 community feedback sessions with older adults, caregivers, persons with disabilities, and service providers across a range of topic areas and localities throughout the county for programs and services included in the Aging Roadmap and Area Plan. Many underserved communities including people of color, individuals with limited English proficiency, LGBTQI+ individuals, persons with Alzheimer’s Disease and related dementias, and low-income individuals provided input to AIS during feedback sessions. Additionally, AIS conducted a public hearing on March 11, 2024 for the Area Plan, where services recipients and other members of the public provided input on the resources, services, and programs related to many of the funding sources included in today’s request. Translation services for the feedback sessions and public hearing were made available in county threshold languages. AIS also advertised the public hearing in all of the county threshold languages.
AIS will continue to seek community input and feedback through public hearings held annually during the annual update of the Area Plan, a planning document required by the Older Americans Act (OAA), detailing how AIS will utilize funds received through the OAA to provide services that meet the identified needs of older adults, persons with disabilities and their caregivers throughout the county. Community input and collaboration are also obtained through Aging Roadmap community teams, comprised of community members, subject matter experts, and County staff to develop and implement goals in the 10 priority areas of the Aging Roadmap. Today’s recommendations will allow the County to continue administering vital programs and services for older adults and persons with disabilities, improving the quality of life for equity-seeking groups of all ages, including Black, Indigenous, and people of color, women, persons with disabilities, immigrants, and the LGBTQI+ community.
SUSTAINABILITY IMPACT STATEMENT
Working with partners to improve and expand programs and services that contribute to the safety and welfare of older adults and persons with disabilities will advance the County of San Diego (County) Sustainability Goal #1 to engage the community in meaningful ways; Sustainability Goal #2 to provide just and equitable access to County services; and Sustainability Goal #4 to protect the health and well-being of everyone in the region. Specifically, programs and services provided with this funding allow older adults and persons with disabilities to remain safely in their homes and access necessary community resources. Additionally, the funded programs help meet the needs of caregivers, reduce isolation, and increase social connections. These efforts are designed to improve the overall health and well-being and reduce barriers for underserved populations, which benefits individuals, and the community at large, who include younger generations today and as they age.
FISCAL IMPACT
Funds for this request are included in the Fiscal Year (FY) 2024-25 CAO Recommended Operational Plan in the Health and Human Services Agency. If approved, this request will result in costs of $34,018,262 and revenue of $33,284,979 in FY 2024-25. The funding sources are:
• State General Fund, Federal Medicaid Program;
• Titles III and VII of the Older Americans Act;
• Older Californians Act Modernization;
• Federal and State Health Insurance Counseling and Advocacy Program;
• Federal SNAP-ED/CalFresh - Healthy Living, U.S. Department of Health and Human Services;
• Partners In Care Foundation;
• San Diego Gas & Electric;
• Veterans Administration San Diego Healthcare System;
• San Diego State University Research Foundation;
• Corporation for National & Community Service; and
• University of California San Diego.
A waiver of Board Policy B-29 is requested because the funding does not offset all costs. B-29 costs are $733,283 for FY 2024-25 and will be funded with existing General Purpose Revenue allocated for these programs. The public benefit for providing these services, which allow older adults and those with disabilities to remain safely in their homes and access resources, far outweighs these costs. There will be no change in net General Fund cost and no additional staff years.
BUSINESS IMPACT STATEMENT
N/A
Details
ADVISORY BOARD STATEMENT
The Aging & Independence Services Advisory Council reviewed this item at their regular meeting on April 8, 2024 and recommended approval.
BACKGROUND
According to the California Department of Finance population projections, of the nearly 3.3 million people who currently reside in San Diego County, approximately 710,000 are adults aged 60 or older. By 2030, the number of adults 60 years and older in the county is expected to increase to more than 850,000. Additionally, the fastest growing age group in the county, those 85 years and older, is projected to increase from an estimated 72,600 in 2024 to nearly 87,600 in 2030. The San Diego County Board of Supervisors (Board) has maintained a commitment to programs that ensure the welfare of older adults and persons with disabilities throughout the county. The County of San Diego (County) Health and Human Services Agency, Aging & Independence Services (AIS) administers these programs. Today’s actions request authorization to continue to receive annual funding from the following revenue agreements, memorandum of understanding (MOU), and grants for various programs benefiting older adults and persons with disabilities throughout the county:
AREA PLAN MEMORANDUM OF UNDERSTANDING AND OLDER CALIFORNIANS ACT MODERNIZATION REVENUE AGREEMENTS ($23,233,243)
The Area Plan MOU of $19,415,830 contains State and federal revenue (Titles III and VII of the Older Americans Act (OAA)) and the revenue agreements of $3,817,413 of Older Californians Act Modernization funding disbursed by the OAA. This MOU requires the County matching funds of $699,810. Funding from the MOU and two revenue agreements will be utilized in several contracts, as well as through direct services provided by AIS, to fund various OAA and Federal Administration on Aging services and programs for older adults. These programs include nutrition, social support, preventive health services, and the local Ombudsman and Family Caregiver Support programs. This funding supports: 1) More than 1.5 million nutritious home-delivered meals and congregate meals to more than 8,000 participants annually; 2) Investigations of approximately 1,000 cases by the Long-Term Care Ombudsman to resolve complaints related to care or personal rights at long-term care facilities or other licensed facilities; 3) Services for older adults such as legal services, transportation, and visits at long-term care facilities to provide companionship; 4) Instructors for health promotion activities such as chronic disease self-management and Tai Chi programs for more than 300 individuals; and 5) Family caregivers such as respite services, support groups, educational assistance, legal services, and home modifications. In addition to this Fiscal Year (FY) 2024-25 revenue agreements, previously accepted and executed revenue agreements are being amended to include funding for multiple fiscal years. The California Department of Aging (CDA) is transitioning from revenue agreements to a multi-year MOU for Area Plan services. In accordance with the requirement of the CDA, the MOU and revenue agreements require execution by the Clerk of the Board.
HEALTH INSURANCE COUNSELING AND ADVOCACY PROGRAM AGREEMENT ($714,308)
The Health Insurance Counseling and Advocacy Program (HICAP) is a State and federally funded volunteer-supported program that assists individuals and families with Medicare and other health insurance concerns. AIS also oversees the HICAP program for Imperial County through a contracted service provider. This revenue funds the HICAP program to conduct over 90 community education forums about healthcare-related issues and provides counseling and advocacy to assist over 5,300 individuals annually with health billing claims and insurance. The CDA intends to transition from revenue agreements to a multi-year MOU for HICAP. In accordance with the requirement of the CDA, the revenue agreement or MOU requires execution by the Clerk of the Board.
CALFRESH EXPANSION AGREEMENT AND SNAP-ED/CALFRESH HEALTHY LIVING ($728,811)
In FY 2022-23, CalFresh Expansion and SNAP-Ed/CalFresh Healthy Living funding were combined into one agreement and included funding for multiple federal fiscal years. CalFresh Expansion, as part of the FY 2018-19 State Budget Omnibus Trailer Bill, Assembly Bill 1811, expanded CalFresh benefit eligibility to include persons receiving or authorized to receive both Supplemental Security Income program and State Supplementary Payment program benefits, provided all other eligibility criteria are met. In FY 2023-24, funds were used to provide information regarding the expanded CalFresh eligibility and application assistance to approximately 2,000 older adults in the county. The CalFresh Healthy Living (known federally as SNAP-Ed) federal funding provides nutrition education for CalFresh-eligible populations. The FY 2024-25 funding will allow AIS to provide nutrition education and physical activity programs for new cohorts and reach approximately 250 older adults through different virtual and in-person offerings. AIS will also provide training and technical assistance to community partners on implementing policy, system, and environmental changes to improve access to healthy food and physical activity for older adults. The FY 2024-25 funding will allow AIS to not only provide outreach and application assistance, but also voter registration information. The original FY 2022-23 agreement for $448,546 was amended to include the FY 2023-24 allocation of $1,050,569 and FY 2024-25 allocation of $728,811 for a total revised contract amount of $2,227,926 covering three federal fiscal years. In accordance with the requirement of the CDA, the amended revenue agreement requires execution by the Clerk of the Board.
MEDICARE IMPROVEMENTS FOR PATIENTS AND PROVIDERS ACT AGREEMENT ($281,195)
The Medicare Improvement for Patients and Providers Act (MIPPA) provides federal funding for outreach to Medicare beneficiaries who are likely to be eligible but are not currently receiving supplemental Medicare benefits. Through a contract with a community-based organization, this revenue allows AIS to provide outreach activities. These countywide outreach activities include enrolling eligible Medicare beneficiaries into the Low-Income Subsidy and Medicare Savings Program, enrolling beneficiaries who reside in rural areas into Medicare Part D benefits, providing education on disease prevention, and increasing awareness of expanded Medicare wellness and supplemental benefits. The current FY 2023-24 funding allows enrollment of approximately 700 eligible Medicare beneficiaries into the Low-Income Subsidy and Medicare Savings program. The Low-Income Subsidy program assists people with limited income and resources to lower or cut Medicare Part D costs, which provides prescription drug coverage. The Low-Income Subsidy program assists with the cost of prescription drugs, including deductibles and copays. The Medicare Savings program assists with Medicare premiums and other costs, like deductibles and copayments. The CDA is transitioning from revenue agreements to a multi-year MOU for MIPPA. In accordance with the requirement of the CDA, the MOU requires execution by the Clerk of the Board.
MULTIPURPOSE SENIOR SERVICES PROGRAM AGREEMENT ($3,679,572)
The Multipurpose Senior Services Program provides State and federal funding for case management eligible older adults, aged 65 and over, who receive Medi-Cal and are at-risk for institutional care. The program allows frail older adults to safely remain in their homes at a lower cost than nursing homes. The program maintains a caseload of approximately 690 older adults and serves these clients for as long as needed.
SAN DIEGO GAS & ELECTRIC AGREEMENT ($35,000)
The County award-winning Cool Zone program provides relief from the heat for hundreds of individuals throughout the county through funding from San Diego Gas & Electric (SDG&E). The program works with local community establishments and focuses on older adults, persons with disabilities, or anyone looking to escape the extreme heat during the summer, particularly those living in inland communities where summer temperatures are highest. Funding is utilized to pay for contracted phone staff who help identify Cool Zones for the public and to cover the cost of mailing electric fans to those who qualify. During the summer months of 2023, nearly 700 electric fans were distributed, and nearly 300 calls were received by Cool Zone phone staff.
PARTNERS IN CARE FOUNDATION AGREEMENT ($27,550)
AIS enters into revenue agreements with hospitals, health plans, and other healthcare entities to improve coordination of care and chronic disease self-management for vulnerable residents. Currently, AIS has a revenue agreement with Partners in Care Foundation to provide evidence-based fall prevention and chronic disease self-management education workshops for older adults and caregivers. Participants may be referred directly by Partners in Care Foundation or through collaboration with a network of other partners. Through this agreement, AIS serves approximately 100 participants per year.
VETERANS ADMINISTRATION SAN DIEGO HEALTHCARE SYSTEM AGREEMENT ($4,304,722)
The total funding of $4,304,722 allows AIS to continue to provide a veteran-directed care program, serving veterans of any age who need assistance with activities of daily living, are isolated, or whose caregiver is experiencing burden. Through federal funding, the program provides the opportunity for veterans to receive home and community-based services to avoid institutionalization and to continue to live in their homes and communities. Currently, an average of 45 veterans are served by the program monthly. The increase of $2,440,572 in funding for FY 2024-25 will allow the program to expand and serve up to 90 veterans per month.
SAN DIEGO STATE UNIVERSITY RESEARCH FOUNDATION/GERIATRIC WORKFORCE ENHANCEMENT PROGRAM ($125,000)
This funding allows County staff to support the Geriatric Workforce Enhancement Program (GWEP) and efforts facilitated by a federal grant received by San Diego State University’s (SDSU) San Diego Imperial Geriatric Education Center (SDIGEC). A subgrant to AIS in the amount of $125,000 is budgeted for County staff to participate in the SDIGEC Leadership Team meetings, to provide dementia-friendly and related training to local service providers, to create and update a dementia caregiver guide, and sector specific guides containing information and tips for recognizing and working with people who may live with Alzheimer’s disease or related dementias.
UNIVERSITY OF CALIFORNIA SAN DIEGO/DEMENTIA CARE AWARE ($44,000)
The Dementia Care Aware funding allows AIS staff to contribute to outreach, engagement, referrals, and caregiver support, in addition to providing expertise pertaining to local dementia aligned initiatives and training of service providers. Dementia Care Aware provides a statewide standard of care for dementia screening in California through equity-focused, culturally appropriate training for primary care providers across all payers, including Medicare, Medi-Cal, and other coverage.
CORPORATION FOR NATIONAL & COMMUNITY SERVICE GRANT ($111,578)
This federal grant funds the Retired and Senior Volunteer Program, which encourages older adults, aged 55 and older, to participate in their communities through volunteer service opportunities. AIS administers the program, which currently has 994 volunteers who record over 214,000 volunteer hours annually. This grant requires County matching funds of $33,473.
In addition to requesting authorization to continue to receive annual funding for the programs listed above, today’s action requests authorization to pursue future funding opportunities. Future funding opportunities help support goals and priorities within the Aging Roadmap and ensure communities support the health, safety, and wellness of residents of all ages.
LINKAGE TO THE COUNTY OF SAN DIEGO STRATEGIC PLAN
Today’s proposed action supports the County of San Diego 2024-2029 Strategic Plan Initiatives of Sustainability (Resiliency), Equity (Health), and Community (Quality of Life), and the regional Live Well San Diego vision by continuing services that assist vulnerable older adults, disabled residents, their caregivers, and military veterans of San Diego County.
Respectfully submitted,
SARAH E. AGHASSI
Interim Chief Administrative Officer
ATTACHMENT(S)
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