DATE: September 6, 2022
TO: Board of Supervisors
SUBMITTED BY: David Luchini, RN, PHN, Director
SUBJECT: Future of Public Health Funding Award Agreement
RECOMMENDED ACTION(S):
TITLE
1. Approve and authorize the Chairman to execute a retroactive Future of Public Health Award Agreement with California Department of Public Health, effective July 1, 2022 through June 30, 2023, with the allocated funds to be available for encumbrance or expenditure until June 30, 2024 ($6,126,172).
2. Retroactively authorize the Director of Public Health’s previous submittal of the Acknowledgement of Allocation Letter acknowledging receipt of the letter and accepting the funds to be used as outlined under the submission requirements.
3. Approve and authorize the Director of Public Health, or designee, as signatory on behalf of the Board of Supervisors on associated grant documents, including submission of all future reports, claims, and adjustments to subsequent Future of Public Health Funding work plans and spend plans, as well as the Annual Certification form.
REPORT
There is no additional Net County Cost associated with the recommended actions. Approval of the recommended actions will provide the Department of Public Health with funding from the California Department of Public Health (CDPH) for public health workforce and infrastructure, referred to as Future of Public Health (FoPH) funding. The funding will support hiring and retention of permanent staff, equipment, supplies and other related administrative costs.
It should be noted that the Department received the Acknowledgement of Allocation letter on June 30, 2022. The letter was required by CDPH in advance of the Work Plan and Spend Plan due date of September 15, 2022; therefore, the Department submitted the letter on July 27, 2022 contingent upon the Board’s approval.
The third recommended action will authorize the Director of Public Health, or designee, to sign and submit required documentation including the Acknowledgement of Allocation letter, work plans, spend plans, invoices, reports, and Annual Certification form. This item is countywide.
ALTERNATIVE ACTION(S):
There are no viable alternative actions. Should your Board not approve the recommended actions, the Department would not be able to accept the FoPH funding to improve public health workforce and infrastructure, which will impact much needed public health services to the community. The Department would need to submit an additional acknowledgement letter to CDPH rejecting the funds.
RETROACTIVE AGREEMENT:
The recommended allocation is retroactive to July 1, 2022 and was received from CDPH on June 30, 2022. The time required to prepare CDPH’s requested documents for the recommended allocation, including the work and spend plan attachments, did not allow presentation to your Board at an earlier date.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended actions. CDPH approved a non-competitive FoPH funding allocation ($6,126,172) to the County for public health workforce and infrastructure in FY 2022-23. These funds are considered ongoing funds and part of the ongoing baseline state budget thus additional annual allocations similar to FY 2022-23 are expected. Funds allocated for this initial 12-month period allowed for encumbrance or expenditure through the following year, June 30, 2024. At least 70% of the funding ($4,288,320) must be dedicated to support hiring permanent staff, including benefits, training and activities that support the recruitment and retention of public health staff. No more than 30% ($1,837,852) may be used for equipment, supplies and other administrative purposes such as facility space, furnishings, and travel. Subsequent budget and salary resolutions will be presented to your Board once CDPH has approved the Work Plan and Spend Plan submitted.
DISCUSSION:
Effective July 1, 2022, the State of California Budget Act of 2022 provides $200,400,000 annually to local health jurisdictions (LHJ) to support public health workforce and infrastructure. Each LHJ will receive a base funding amount of $350,000 per year. The remaining balance of the appropriation will be allocated to each LHJ based on most recent population data, poverty data, and the share of the LHJ’s population that is Black/African American/Latinx/or Native Hawaiian/Pacific Islander. Based on the factors mentioned above, the Department has been allocated $6,126,172, as the first year allocation, of which at least 70% must be dedicated to support hiring permanent staff, including benefits, training and activities that support the recruitment and retention of public health staff. No more than 30% may be used for equipment, supplies and other administrative costs such as facility space, furnishings, and travel. Funding provided under the recommended agreement shall be used to supplement and not supplant all other specific local county funds.
The FoPH funding offers a unique opportunity to strengthen and expand local public health workforce, particularly to fill staffing gaps identified during the COVID-19 pandemic. In FY 2020-21, your Board approved the Department’s addition of 36 positions to address COVID-19 response, using State and Federal sources which are expected to expire in 2024. FoPH funding recipients are encouraged to transition limited-term positions previously funded through limited-term federal funding into permanent positions for the LHJs. Reallocating these positions into new permanent duties with the FoPH funding will eliminate the need to request creation of additional positions.
FoPH funding allows the County to continue work towards being agile, adaptive, and responsive to the increasingly complex and emerging public health challenges facing its diverse communities. Approval of the recommended actions will allow the Department to use the FoPH funding to improve workforce recruitment and retention, local health access to disadvantaged communities, surveillance and detection of communicable diseases, and overall population health through evaluation of policies and systems in place. The Department’s Workforce Development team will evaluate training strategies, increase employee communication strategies with Department Administration, and coordinate with the County Administrative Office and County Human Resources Department to strategically address the high vacancy rates in specific classifications to improve recruitment and retention rates. FoPH funding will also allow the Department’s Workplace Wellness Committee to implement various wellness activities throughout the Department to improve employee health and well-being.
California’s Healthy Places Index and Fresno County’s Health Priority Index will be utilized to assess overall population health and guide work plan activities. The FoPH funding will allow the Department to establish infrastructure to expand the community health worker network with local community-based organizations that provide culturally competent and linguistically appropriate services to connect our disadvantage neighborhoods to healthcare. A rural mobile health program will be developed in collaboration with local medical providers. Additionally, approval of the recommended agreement will:
• increase the Public Health Nursing division's capacity in targeted geographic areas;
• add support to improve epidemiology capabilities;
• increase staff support for communicable disease investigation and contact tracing,
• increase public health laboratory personnel and equipment to expand existing testing capacity;
• support the Health Policy and Wellness division’s activities to evaluate local health policies and general policies for potential improvement in addressing local health disparities;
• increase the Environmental Health division’s capacity to evaluate and address illegal dumping, housing, identification of new Certified Unified Program Agencies (CUPA) facilities, tobacco retail inspections, pool inspections, rabies control, and water well program resources;
• allow the Emergency Services division to better support all the functions of the division in emergency preparedness, Office of Emergency Services, Public Health Emergency Preparedness, and management of the Central California Emergency Medical Services Agency and support lease costs for a new facility location that can consolidate all services.
CDPH required submission of an Acknowledgment of Allocation Letter in advance of the Work Plan and Spend Plan due date. The signed letter served to acknowledge receipt of the FoPH Allocation Letter and acceptance and agreement to use the funds as outlined under the Submission Requirements section of the letter. To meet the deadline, the Department submitted the acknowledgement letter signed by the Director of Public Health contingent upon approval by your Board. Approval of the recommended actions would retroactively authorize the Director of Public Health’s submission of the acknowledgment letter and authorize the Director, or designee, to submit all future reports, claims, and adjustments to subsequent FoPH funding work plans and spend plans, as well as the Annual Certification form.
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Future of Public Health Funding Award Agreement FoPH-011
CAO ANALYST:
Ron Alexander