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DATE: |
December 9, 2025 |
03 |
SUBJECT
Title
SHERIFF - REQUEST FOR AUTHORIZATION TO ISSUE A COMPETITIVE SOLICITATION FOR PHARMACY SERVICES AT DETENTION FACILITIES (DISTRICTS: ALL)
Body
OVERVIEW
The Sheriff's Office (Sheriff) provides comprehensive health care services to incarcerated persons in custody at all seven Sheriff’s detention facilities across San Diego County as required by Title 15 of the California Code of Regulations. Impacts from Assembly Bill 109, enacted in 2011, which mandated the Sheriff's Office house defendants convicted of less serious felonies to serve their time in local county jail rather than in state prison, include elevated medical needs of the incarcerated population. As the incarcerated population needs have changed and obligations for medical services have increased to address complex diagnoses, there has been a 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.
On August 4, 2020 (1), the Board of Supervisors 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 to Naphcare, Inc. and services began on June 1, 2022. The contract for comprehensive health care services includes provisions for pharmacy services which encompasses on-site medication administration and pharmaceutical operations. 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 through the Justice-Involved Reentry Initiative also known as Medi-Cal Transformation Initiative. Pharmacy services are required as per this initiative. The California Department of Health Care Services (DHCS) requires correctional facilities to obtain medications from a Medi-Cal enrolled pharmacy to receive reimbursement for these prescriptions. The Sheriff’s current health care vendor providing pharmacy services, Naphcare, Inc. is not a Medi-Cal enrolled pharmacy and has confirmed it will not seek enrollment. Continuing to use a non-enrolled pharmacy would render the County unable to comply with Medi-Cal billing requirements and preclude the ability to seek reimbursement for prescribed medications provided to incarcerated persons upon release.
Today's action requests the Board to authorize a competitive solicitation for pharmacy services for the Sheriff’s detention facilities for one year, with nine option years, and a six-month extension if needed, subject to the availability of funds, and to amend the contract as required to reflect changes to services and funding allocations, subject to the approval of the Sheriff.
RECOMMENDATION
SHERIFF
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 pharmacy services in Sheriff’s detention facilities, and upon successful negotiations and determination of a fair and reasonable price, award a contract for an initial term of one year, with nine 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 Sheriff.
EQUITY IMPACT STATEMENT
The U.S. Centers for Disease Control and Prevention (CDC) Healthy People 2030 defines 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 pharmacy builds greater health equity for our incarcerated population. It gives incarcerated people access to high quality and affordable pharmaceutical services while in custody, providing them with more adequate medical care. The Sheriff's Office is dedicated to advancing health equity outcomes for incarcerated persons and having an on-site pharmacy 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 an on-site pharmacy 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 2025-26 Operational Plan for the Sheriff’s Office. If approved, this request will result in an estimated annual cost of $8,896,840 for the current fiscal year. Subsequent year costs will be included in future years Operational Plans for the Sheriff’s Office based on amounts included in the Fiscal Year 2025-26 Adopted Operational Plan. The funding source is existing General Purpose Revenue and anticipated funds for medical care services. There will be no change in net General Fund costs and no additional staff years.
BUSINESS IMPACT STATEMENT
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Details
ADVISORY BOARD STATEMENT
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BACKGROUND
The Sheriff’s Office (Sheriff) operates seven jail facilities across the County of San Diego (County) with an average daily incarcerated persons population of 4,342. 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. This significantly 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.
On August 4, 2020 (1), the Board of Supervisors 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 to Naphcare, Inc. and services began on June 1, 2022. The contract for comprehensive health care services includes provisions for pharmacy services which encompasses on-site medication administration and pharmaceutical operations.
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. Pharmacy services, required per this initiative, include the provision of medications in-hand upon release to incarcerated persons enrolled in Medi-Cal. The California Department of Health Care Services (DHCS) requires correctional facilities to obtain medications from a Medi-Cal enrolled pharmacy, using all standard Medi-Cal Rx processes, to receive reimbursement for the prescriptions. Correctional facilities that currently do not have a Medi-Cal-enrolled pharmacy are required to enroll their pharmacy as a Medi-Cal provider, contract with a Medi-Cal-enrolled pharmacy vendor or obtain medications from a Medi-Cal enrolled community pharmacy. Correctional facilities are required to bill and submit claims to Medi-Cal for all prescription medications provided upon release. Only Medi-Cal-enrolled pharmacies may submit claims for reimbursement for medications under the Medi-Cal Transformation initiative. The Sheriff’s Office’s current health care vendor providing pharmacy services is not a Medi-Cal-enrolled pharmacy and the vendor confirmed it will not seek enrollment. Continuing to use a non-enrolled pharmacy would render the County unable to comply with Medi-Cal Rx billing requirements and preclude the ability to seek reimbursement for prescribed medications provided to enrolled incarcerated persons upon release. The Sheriff’s Office will be required to contract with a pharmacy provider that will enroll as a Medi-Cal pharmacy to allow for billing and reimbursement for prescribed medications pursuant to the Medi-Cal Transformation initiative.
The competitive solicitation will ensure a Medi-Cal enrolled pharmacy vendor will provide pharmacy services for the Sheriff-operated County jail system, work collaboratively with Sheriff’s management, and meet all requirements set forth by State of California and federal regulations.
Today’s action requests the Board to authorize a competitive solicitation for pharmacy services for the Sheriff’s detention facilities. If approved, the solicitation will result in awarding a contract for an initial term of one year, with nine option years, and a six-month extension. A 10-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 pharmacy services supports the Community Initiative of the County of San Diego 2025-30 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(S)
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