DATE: August 11, 2026
TO: Board of Supervisors
SUBMITTED BY: Joe Prado, Director, Department of Public Health
SUBJECT: Retroactive Revenue Award from the California Department of Public Health for Tuberculosis Control Program
RECOMMENDED ACTION(S):
TITLE
1. Approve and authorize the Chairman to execute a retroactive Award Agreement from the California Department of Public Health for the Tuberculosis Control Local Assistance Base Award ($267,374) and includes Food, Shelter, Incentives and Enablers ($17,595) funds, effective July 1, 2026, through June 30, 2027;
2. Approve and authorize the Director of the Department of Public Health to execute the State Contractor’s Release for the final invoices; and
3. Approve and authorize the Department of Public Health’s Tuberculosis Control Program to purchase gift cards.
REPORT
There is no additional Net County Cost associated with the recommended actions. Approval of the first recommended action will fund tuberculosis (TB) control activities in the Department of Public Health (Department), which includes screening, case management, treatment, contact investigation, and incentives to improve treatment compliance of TB patients. Approval of the second recommended action will allow the Director of the Department to execute the Contractor’s Release for the final invoice at the close of the grant term. Approval of the third recommended action will enable the TB Control Program to purchase gift cards in alignment with the Food, Shelter, Incentives, and Enablers (FSIE) portion of this funding. The activities are funded with State and Federal funding, and any additional costs will be covered with Health Realignment. This item is countywide.
ALTERNATIVE ACTION(S):
There is no viable alternative action. Should your Board not approve the recommended actions, the Department would be unable to fully fund TB control activities in the County, resulting in an increased risk to the community and a reduction of TB-related services provided to County residents.
RETROACTIVE AGREEMENT:
The recommended agreement is retroactive to July 1, 2026. The TB Base Award and FSIE Award agreement was received from the California Department of Public Health (CDPH) on May 29, 2026. The agreement is being brought to your Board in accordance with the agenda item processing timelines.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended actions. The sum of the awards will provide $267,374 in revenue in the current fiscal year. The Base Award is comprised of State ($123,506) and Federal ($143,868) funds. The State funds portion of the award includes the full FSIE amount ($17,595). The Department will cover any additional costs that may arise with Health Realignment. Sufficient appropriations and estimated revenues will be included in the Department’s Org 5620 FY 2026-27 Recommended Budget.
DISCUSSION:
In 2025, the Department’s TB Control Program provided treatment, case management, contact investigation, referral, and follow-up activities for 50 county residents newly diagnosed with active TB. Department staff also provided care for patients diagnosed prior to 2025 who had not yet completed treatment. The standard treatment regimens are six to twelve months; however, patients with drug-resistant TB may be treated as long as two years. Active TB patients receive Directly Observed Therapy (DOT) or video DOT (vDOT) in which program staff visit or view a daily video recording of patients to ensure ingestion of appropriate TB medications. TB Control Program staff provided 6,095 DOT visits and 4,589 vDOT viewings in 2025.
FSIE funds are intended to help motivate and support patients in starting and/or completing treatment, as well as in adhering to it. The funds may be used to house infectious patients or to purchase food, incentives, and enablers for patients who are confirmed or suspected to have TB. These funds have been used in the past for housing infectious patients when needed, to purchase bus passes, to buy High-Efficiency Particulate Air (HEPA) filters for patients, and to purchase gift cards. During 2025, the TB control program distributed 1,258 gift cards to patients based on need to incentivize or assist them in getting treated for TB, with most of the gift cards being $10. A wide variety of gift card types have been purchased, including FoodMax, Subway, Taco Bell, and Walmart ATF/ATL (alcohol, Tobacco, and firearm/lottery) restricted cards. The gift cards are only purchased at the end of the fiscal year as the option of last resort to maximize the grant funds once it is certain the funds will not be needed for other higher priority options. The TB control program also has Policy and Procedure Guidelines for the purchase and distribution of gift cards to prevent abuse, which are reviewed by the DPH Business Office.
The Department also screened an additional 898 new patients with inactive TB or a disease other than TB in 2025. The Department’s Hospital Liaison and other TB Control Program staff closely monitored and managed 249 cases of the 1,275 additional cases as follow-up to immigration screening mandated by Federal law. Residents at high risk of developing TB include close contacts with active TB patients and people experiencing homelessness. Approximately 393 close contacts were evaluated for latent TB infections, and over 220 TB screenings were conducted on individuals who were identified as unhoused. In FY 2025-26, the County expended an average of $1,123.79 per TB patient for treatment, hospital case management, contact investigation, and/or screening.
The recommended Agreement deviates from the County’s standard indemnification language in that it requires the County to agree to indemnify, hold harmless and defend the State against any claims, losses, or legal costs that arise only from Fresno County’s own actions, such as negligence, willful misconduct, or failure to comply with the terms of the agreement. This is a one-way indemnification, meaning Fresno County is agreeing to protect the State from any liability resulting from the County’s actions, but the State does not provide the same protection to Fresno County. The Department has determined that its acceptance of the indemnification language is advantageous to the County, as the State-grant is a funding source for Fresno County’s TB control and prevention activities, without which the continued provision of these services would be negatively impacted.
REFERENCE MATERIAL:
BAI #51, August 19, 2025
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Agreement with CDPH
On file with Clerk - Standards and Procedures Manual
CAO ANALYST:
Ron Alexander