DATE: September 22, 2026
TO: Board of Supervisors
SUBMITTED BY: John Zanoni, Sheriff-Coroner-Public Administrator
SUBJECT: Amendment XIII to Agreement with California Forensic Medical Group, Incorporated
RECOMMENDED ACTION(S):
TITLE
1. Approve and authorize the Chairman to execute Amendment XIII to Agreement with California Forensic Medical Group, Incorporated (CFMG) to provide CalAIM Justice-Involved pre-release services to adults detained at the Fresno County Jail, effective upon execution with no change to term, and increasing the maximum compensation by $6,104,438 to $400,479,492; and
2. Adopt Budget Resolution increasing FY 2026-27 appropriations and estimated revenues for the Sheriff-Coroner-Public Administrator Org 3111 in the amount of $1,797,018 for Amendment XIII with CFMG (4/5 vote).
REPORT
There is no additional Net County Cost with the recommended actions. Approval of the first recommended action will allow for implementation of targeted pre-release services for adults at the Fresno County Jail (FCJ) under the California Advancing and Innovating Medi-Cal (CalAIM) Justice-Involved (JI) Reentry Initiative. Approval of the second recommended action will increase the FY 2026-27 appropriations and estimated revenues for the Sheriff-Coroner-Public Administrator Org 3111 in the amount of $1,797,018. Funding for the recommended amendment will be through Providing Access and Transforming Health (PATH) Capacity Building Program grant funds and Medi-Cal Federal Financial Participation (FFP). This item is countywide.
ALTERNATIVE ACTION(S):
If the recommended actions are not approved, the County will not be in compliance with legally-required CalAIM JI reentry mandates at the FCJ.
FISCAL IMPACT:
There is no additional Net County Cost with the recommended actions. The recommended amendment incorporates increases for the maximum compensation by $6,104,438 to $400,479,492, funded through the PATH Capacity Building Program grant and FFP funds. This increase covers CalAIM implementation consulting services, CalAIM Adult Facility staffing, and Medication Assisted Treatment (MAT) staffing and program costs, in addition to a Medi-Cal billing administration fee equal to 7% of FCJ's gross JI Medi-Cal reimbursement claims, not to exceed an estimated $114,323 for FY 2026-27 (pro-rated to reflect the October 1, 2026 Go-Live), $190,624 for FY 2027-28, and $232,099 for FY 2028-29. The JI Medi-Cal reimbursement fees performed under the recommended amendment are paid for with the revenue received from CalAIM JI Reentry Initiative. Sufficient appropriations and estimated revenues will be included in future budget requests for the duration of the term.
Approval of the recommended actions will increase the Sheriff’s agreement maximum by $6,104,438, for a total of $400,479,492. The yearly breakdown is as follows:
9/22/2026 - 6/30/2027 $1,797,018
7/1/2027 - 6/30/2028 $2,085,598
7/1/2028 - 6/30/2029 $2,221,822
Total $6,104,438
DISCUSSION:
California is the first state to offer Medi-Cal services to youth and adults in correctional settings up to 90 days before release, expanding access beyond the traditional post-release model. Through a federal Medicaid 1115 waiver, the California Department of Health Care Services (DHCS) is establishing a coordinated reentry process to connect individuals with needed health care services upon release.
On December 3, 2024, your Board approved Amendment XII (Agreement A-24-634) with CFMG (Wellpath) for comprehensive medical and behavioral health care services, including substance use disorder services, for adults detained at FCJ.
On April 7, 2026, your Board approved Agreement A-26-128 with WestCare California, Inc. to provide CalAIM JI pre-release care coordination services at FCJ. The recommended amendment will authorize Wellpath to provide CalAIM JI reentry services consistent with the Fresno County Sheriff Office’s CalAIM JI Readiness Assessment, with an anticipated Go-Live date of October 1, 2026. Under the recommended amendment, Wellpath will collaborate with WestCare and the County’s Managed Care Plans to develop reentry care plans and coordinate services for eligible adults transitioning back into the community. Additionally, Wellpath’s subcontracted billing vendor, Medusind, Inc., will conduct audits and provide quality assurance to ensure the claims submitted for the 90-day pre-release medical, mental health, and substance use disorder services delivered at FCJ are accurate and compliant with State and Federal requirements. Under the recommended amendment, Medusind, Inc. will receive 7% of the total gross revenue collected by the County. Wellpath will also ensure that its staff are credentialed to bill Medi-Cal and will provide training to support accurate and complete billable documentation. Unlike the youth population served under Probation’s parallel amendment, not all adults detained at FCJ qualify for Medi-Cal, and not all services delivered within the 90-day pre-release window will be reimbursable. The Fresno County Sheriff’s Office is working with the Business Office to determine the anticipated reimbursement rate for the eligible population.
REFERENCE MATERIAL:
BAI #31, April 7, 2026
BAI #8, December 3, 2024
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Amendment XIII with CFMG
On file with Clerk - Budget Resolution
On file with Clerk - Digital Signature Certificate
CAO ANALYST:
Samantha Buck