Supervisors approve $20.4M Medi-Cal gap pilot 5-0; jail no-bid order and sheriff biometric buy pass on consent

San Diego County supervisors voted 5-0 on Oct. 27 to spend $20.4 million, $17.6 million of it from county reserves, on a one-year pilot to provide free primary care and benefits help to residents expected to lose Medi-Cal under new federal work requirements.

The board also approved, without discussion on its consent agenda, a $5 million Sheriff's Office purchase of a biometric identification system and a $10.86 million no-bid change order for work at the San Diego Central Jail. The consent agenda passed 5-0.

The Safety Net Bridge pilot sets aside $12.4 million for no-cost primary care visits and same-day prescriptions through contracted providers, $6.6 million for Medi-Cal and CalFresh navigation, including $5.9 million in contracts with community groups, $750,000 for health fairs and $675,000 for county staff. Besides the reserves, $2.15 million comes from one-time social services revenue. The staff report says about $25.1 million will remain in the county's safety net reserve. Supervisor Monica Montgomery Steppe made the motion and Chair Terra Lawson-Remer seconded it. Staff must bring a midpoint progress report and return within 12 months with data before any extension.

County staff estimate that starting in March 2027, 68,761 of the 309,939 local Medi-Cal recipients subject to the new federal work and community engagement rules could lose coverage.

A related item overhauling County Medical Services, the county's indigent care program, passed 4-1, with Supervisor Jim Desmond voting no. The reforms remove property liens, credit checks and the reimbursement agreement requirement for applicants. The board introduced the lien ordinance on first reading and will take it up again Nov. 17.

The biometric item authorizes a competitive solicitation for an Automated Biometric Identification System to replace the fingerprint system the county has used since 2011. The contract can run five years with five one-year options. The $5 million comes from the Sheriff Fingerprint ID Trust Fund, which collects a $2 fee on each vehicle registered in the county. The sheriff's letter said the system "is limited to fingerprints and palm prints" and that "no expansion is planned at this time," but the platform "retains the capability to enable other modalities."

The Central Jail change order, also approved on consent, waives the county's competitive bidding policy and lets Balfour Beatty Construction add up to $10,858,000 in kitchen cooler, dishwasher, air handler, plumbing and bathroom work to its existing contract. The board found that bidding the work would be "unavailing, impractical" and would not produce any public advantage.

Also on consent, the board added one sheriff's school resource officer for Vista at a first-year cost of $336,945, paid by the city of Vista, and waived its policy requiring full cost recovery on revenue contracts.

On the jail medical claims contract with United HealthCare Services, known as AmeriChoice, the board voted 5-0 on Desmond's motion to approve the sheriff's pass-through payment model. That supersedes a condition the board set in March that the county not be responsible for cost overruns. The sheriff said AmeriChoice processes claims but does not provide or control care, so the county remains responsible for inmates' medical bills. Desmond's motion added reporting requirements: a first report within 90 days, quarterly reports after that, and written notice within 30 days if off-site medical spending exceeds projections, along with corrective actions.

A late item from Lawson-Remer, approved on consent, amended County Counsel Damon Brown's employment agreement so the county pays a tax gross-up giving him up to $20,000 after taxes in relocation expenses. A Sept. 1 amendment covering up to $4,800 in tax on those expenses was "insufficient to fully reimburse" him, the board letter says.

Desmond also voted no on accepting a state grant for workers' rights enforcement by County Counsel, which passed 4-1.

At a special meeting Oct. 28, the board voted 3-2 in closed session to authorize County Counsel to file a lawsuit, with Supervisors Joel Anderson and Desmond voting no. The county said details will be released once the case is filed.