DATE:
March 24, 2026
03
TO:
Board of Supervisors
SUBJECT
SHERIFF - REQUEST APPROVAL TO AUTHORIZE AN AMENDMENT WITH UNITED HEALTHCARE (AMERICHOICE) AND AUTHORIZE A COMPETITIVE SOLICITATION FOR AN ADMINISTRATIVE SERVICES ORGANIZATION (DISTRICTS: ALL)
Body
OVERVIEW
The San Diego Sheriff's Office (Sheriff's Office) has a need for an Administrative Services Organization (ASO) to support the Medical Services Division and seeks approval to negotiate with United HealthCare Services, Inc. (AmeriChoice) for the management of health care services provided to individuals in custody. The Sheriff's Office contracted medical services provider, NaphCare, currently performs limited administrative functions related to off-site medical care; however, the operational needs of the Sheriff's Office have significantly evolved due to increasing need for hospital care for incarcerated individuals, higher-acuity cases, and the expanded requirements of California Advancing and Innovating Medi-Cal (CalAIM).
The Sheriff's Office is currently facing three significant challenges under the existing contract: (1) administrative and operational capacity is no longer sufficient to manage the increased volume and acuity of off-site hospital care; (2) lack of implementation of CalAIM prerelease Medi-Cal claiming, resulting in potentially missing reimbursement opportunities and compliance risk that will take effect in the future; and (3) off-site medical expenditures are trending toward exceeding NaphCare's annual $20,600,000 cap, creating substantial unbudgeted fiscal burden for the Sheriff's Office. Therefore, the Sheriff's Office requires an ASO with the expertise and infrastructure to manage off-site medical services, process timely CalAIM billing and claims, and support the Medical Services Division moving forward. Contracting with an ASO, such as AmeriChoice, will also provide the Sheriff's Office with enhanced authority and flexibility to negotiate agreements with hospitals and h...
Click here for full text