DATE: January 27, 2026
TO: Board of Supervisors
SUBMITTED BY: Susan L. Holt, Director, Department of Behavioral Health
SUBJECT: Amendment No. 1 to Agreement with JDT Consultants, Inc.
RECOMMENDED ACTION(S):
TITLE
Approve and authorize the Chairman to execute Amendment No. 1 to Agreement No. 25-378 with JDT Consultants, Inc. for Therapeutic Behavioral Services, effective upon execution with no change to the term of August 5, 2025, through June 30, 2030, and increasing the maximum compensation by $3,777,295 to a total of $26,522,011.
REPORT
There is no additional Net County Cost associated with the recommended action. The recommended action will allow the Department to continue to provide Therapeutic Behavioral Services (TBS) to eligible Fresno County Medi-Cal beneficiaries who are under 21 and can benefit from one-to-one therapeutic contact with a mental health specialist to maintain placement at the lowest appropriate level. The proposed amendment will be funded by Mental Health Realignment and Short/Doyle Medi-Cal Federal Financial Participation (FFP). This item is countywide.
ALTERNATIVE ACTION(S):
Should your Board not approve the recommended action, the Department would risk being unable to provide TBS as mandated by the judgment and permanent injunction issued in Emily Q. v. Bonta (C.D. Cal. 2001) 208 F.Supp.2d 1078 for all potential persons served and will impact compliance with the federal court order. First-quarter utilization data comparisons from FY 2024-2025 and FY 2025-2026 determined referrals increased a total of 47.5% and number of services rendered per person served increased 29.5%. The recommended action serves to increase the maximum compensation accordingly to account for the increased trend in utilization to prevent any potential gaps and/or delays in receiving essential mental health services.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended action. The maximum amount of the agreement ($26,522,011) will be funded with Medi-Cal FFP and Mental Health Realignment. Sufficient appropriations and estimated revenues are included in the Department of Behavioral Health’s Org 5630 FY 2025-2026 Adopted Budget and will be included in future budget requests for the duration of the term of the Agreement. Actual costs will be determined by actual services provided.
DISCUSSION:
In 1999, the U.S. District Court issued a preliminary injunction requiring the State Department of Health Care Services (DHCS) to provide TBS to children/youth under 21 years of age, through the Medi-Cal Early and Periodic, Screening Diagnosis and Treatment (EPSDT) benefit (California Code of Regulations Title 9, Chapter 11). On May 10, 2001, a judgement and permanent injunction in Emily Q. v. Bonta was issued requiring all Behavioral Health Plans to ensure access to and provide or arrange for the provision of TBS. As Fresno County’s Behavioral Health Plan, the Department of Behavioral Health (DBH) has been providing TBS since November 2000.
On August 5, 2025, the Board approved Agreement No. A-25-378 with JDT Consultants, Inc. for Therapeutic Behavioral services.
TBS is an intensive, individualized, one to one behavioral coaching program between a mental health specialist and the person served for a specified and limited period. TBS can help the person served learn strategies and skills to increase the kinds of behavior that will allow them to be successful in their current environment and learn new ways of reducing and managing challenging behaviors. TBS focus on behaviors and symptoms, which may jeopardize existing placements, or act as barriers to a lower level of placement or the completion of specific treatment goals. The TBS coach meets with persons served at their home, school, or a place where the person served is most comfortable, during times most therapeutic and when interventions are most needed. Persons served are referred by the County’s Department of Social Services, DBH, contracted mental health providers, families, care givers, and courts.
TBS is only available to those children and youth with full scope Medi-Cal benefits who are receiving ongoing mental health services and meet medical necessity and class certification criteria as outlined in the TBS documentation manual. The proposed maximum compensation is based on a comparison of first-quarter utilization data from FY 2024-2025 and FY 2025-2026. Referrals increased from 80 to 118 (47.5%), and the number of services per person served increased from 24.99 to 32.38 (29.5%) during the same period. Contributing factors to the increase of services were identified as but not limited to state of affairs of the Country resulting in economic stress on the family, a higher level in acuity, staff retention increasing and improving collateral contacts with parents. The increase of the maximum compensation is necessary to continue providing TBS services to persons served without exceeding the current maximum compensation.
OTHER REVIEWING AGENCIES:
The Behavioral Health Board was notified of the recommended Amendment during the January 2026 meeting.
REFERENCE MATERIAL:
BAI #44, August 5, 2025
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Amendment No. 1 with JDT Consultants, Inc.
CAO ANALYST:
Ronald Alexander