DATE: September 5, 2023
TO: Board of Supervisors
SUBMITTED BY: David Luchini, RN, PHN, Director, Department of Public Health
SUBJECT: Retroactive Approval of Submission of Application and Notice of Awards from the U.S Department of Health and Human Services for Healthy Start Initiative: Eliminating Disparities in Perinatal Health
RECOMMENDED ACTION(S):
TITLE
1. Retroactively approve and authorize the Director of the Department of Public Health’s previous submission of an application to the U.S. Department of Health and Human Services, Maternal and Child Health Bureau, for Healthy Start Initiative: Eliminating Disparities in Perinatal Health grant funds, for the period of April 1, 2019 to March 31, 2024 ($4,885,000).
2. Approve and authorize the Chairman to retroactively accept the Notice of Awards Authorization from the U.S. Department of Health and Human Services for the Healthy Start Initiative: Eliminating Disparities in Perinatal Health, effective April 1, 2019 to March 31, 2024 ($4,885,000).
3. Retroactively approve and authorize the Director of Public Health’s execution of the Federal Assurances and Certifications for the application.
REPORT
There is no additional Net County Cost associated with the recommended actions. Approval of the recommended actions will retroactively approve the Department of Public Health’s (Department) submission of the application for Federal Healthy Start funding ($4,885,000) and retroactively accept the Notice of Awards (NoA) to continue the Babies First program for five years to reduce disparities in infant mortality and adverse perinatal outcomes. The Babies First program provides outreach, education, and home visitation services to low-income mothers and their families. This item is countywide.
ALTERNATIVE ACTION(S):
There are no viable alternative actions. The Healthy Start funding has been utilized by DPH since 2019. Should your Board not approve the recommended action, the Department would not be able to accept current and previous already expended grant funds from the U.S. Department of Health and Human Services (DHHS), Health Resources and Services Administration (HRSA) and DHHS HRSA may require the County to repay the Federal funds expended since 2019 ($2,787,616).
RETROACTIVE AGREEMENT:
The recommended actions are retroactive to April 1, 2019. The Department conducted an internal review on current grants and discovered the DHHS application and NoA was not presented to the Board in FY 2019-20 for the full grant term of April 1, 2019 to March 31, 2024. The Department attributes this error to staffing oversight, and safeguards have been put in place to make sure this does not occur in the future.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended actions. The DHHS approved a competitive grant allocation to Fresno County in the amount of $950,000 for April 1, 2019 through March 31, 2020 for the Babies First program. Future allocations through March 31, 2024 were allocated in the amount of $980,000 per year. DHHS allocated an additional $15,000 for the FY 2023-24 to purchase Mother and Infant Supply Kits. The Federal government allows an indirect cost recovery of 10% of total direct costs. The Department’s indirect cost rate for FY 2023-24 is 18.314%. The 8.314% difference will be covered by Health Realignment. Sufficient appropriations and estimated revenues were included in the Department’s Org 5620 FY 2019-23 Adopted Budgets and is included in the Department’s Org 5620 FY 2023-24 Recommended Budget.
DISCUSSION:
On March 25, 2014, the Board approved the retroactive submission of the application to DHHS for Health Start funding for the grant period of June 1, 2014 to May 31, 2019 ($3,750,000). On August 19, 2014, the Board approved a retroactive revenue agreement with DHHS for the extension of the FY 2013-14 Healthy Start grant by approving DHHS allocation of $287,500 from June 1, 2014 to August 31, 2014 due to the final determination of grantees to be awarded for the 2014-19 grant period had not been made, therefore, DHHS authorized a NoA to extend the project through August 31, 2014. On December 2, 2014, the Board approved the retroactive Notice of Award (NoA) from DHHS for the Healthy Start funding from September 1, 2014 through May 31, 2019 ($3,532,933).
In the final term of the Healthy Start funding in FY 2018-19, the Department completed a new grant application on November 26, 2018 and received the new NoA on March 18, 2019 for terms April 1, 2019 through March 31, 2024. DHHS continued to reimburse the services provided by the Department’s Babies First program as DHHS did not require a signed document be returned from the County.
Every project applying for funding is required to address the five approaches of Healthy Start: improve women’s health, promote quality services, strengthen family resilience, achieve collective impact, and increase accountability through quality improvement, performance monitoring, and evaluation. Core services include Outreach, Case Management/Care Coordination, Health Education, Interconception Care and Depression Screening and Referral, all of which are provided by Babies First and Maternal, Child and Adolescent Health (MCAH) programs. Services and strategies will be implemented to achieve the grant benchmarks and align with existing community services to sustain community level change within the community system of care.
Approval of the recommended actions will approve the DHHS Healthy Start funding allocations to the Department’s Babies First program to continue addressing significant disparities in perinatal health. The Department’s Babies First program has been receiving the Healthy Start funding since 1997 and was required to compete for continued funding prior to the expiration of the FY 2014-19 grant term cycle. The FY 2019-24 application was submitted on November 26, 2018.
Since April 1, 2019, Babies First has provided services to 462 pregnant and parenting women/teens and 390 children. Nurse case managers and trained health education assistants completed a total of 3,549 home visits, field visits or telehealth visits, 2,584 phone calls, and 6,241 texts. Every pregnant, postpartum women, infant and child served is assessed at least quarterly and screened for depression, intimate partner violence and developmental delays. Babies First has continued to meet the community’s needs by implementing new grant activities to improve perinatal health outcomes and reduce infant mortality by meeting several program objectives. These objectives include increasing the percentage of participants with health insurance and a reproductive life plan. Babies First also hopes to reduce the percentage of pregnancies conceived within 18 months of a previous birth and increase the percentage of participants who engage in safe sleep behaviors, breastfeed, receive screenings for perinatal depression and intimate partner violence and abstain from cigarette smoking during pregnancy.
Approval of the recommended actions will also accept the terms of the grant, which specify that the County must comply with DHHS’s Grants Policy Statements, including if County fails to comply with the remarks, terms, conditions, or reporting requirements, this may result in a draw down restriction being placed on the County’s Payment Management System account or denial of future funding.
REFERENCE MATERIAL:
BAI #44, December 2, 2014
BAI #42, August 19, 2014
BAI #26, March 25, 2014
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - DHHS Healthy Start Funding Application for FY 2019-24
On file with Clerk - Notice of Award Authorization with DHHS FY 2019-24
On file with Clerk - Federal Assurances and Certification
CAO ANALYST:
Ron Alexander