DATE: November 3, 2026
TO: Board of Supervisors
SUBMITTED BY: Joe Prado, Director, Department of Public Health
SUBJECT: Retroactive FY 2026-29 Agreement Funding Application with California Department of Public Health
RECOMMENDED ACTION(S):
TITLE
1. Approve and authorize the Chairman to execute a retroactive revenue Agreement with California Department of Public Health for the Maternal, Child and Adolescent Health, Black Infant Health, and Perinatal Equity Initiative Programs, effective July 1, 2026 through June 30, 2029 ($16,656,034);
2. Approve and authorize the Director of Public Health to approve amendments to the contract expenditure category limits for FY 2027-28 and 2028-29 when the allocation amounts are confirmed and modifications are requested from the California Department of Public Health; and
3. Approve and authorize the Department of Public Health’s Maternal, Child and Adolescent Health, Black Infant Health and Perinatal Equity Initiative Programs to purchase gift cards.
REPORT
There is no additional Net County Cost associated with the recommended actions. Approval of the first recommended action will provide the Department of Public Health (Department) with continued funding support from the California Department of Public Health (CDPH) to the Maternal, Child and Adolescent Health (MCAH), Black Infant Health (BIH), and Perinatal Equity Initiative (PEI) programs. The funding supports salaries, benefits, operational, indirect, and subcontract costs to execute the required services. The MCAH and BIH programs provide outreach, home visitation, health education and linkage to community resources for women and their families. The PEI funding supports local perinatal equity activities to fill gaps in current services and assist with development of a collective impact blueprint to reduce African American infant mortality. Approval of the second recommended action will authorize the Director of Public Health to approve amendments to the contract expenditure category limits for fiscal year (FY) 2027-28 and 2028-29 when the allocation amounts are confirmed and budget changes are requested from CDPH. Approval of the third recommended action will enable the MCAH, BIH, and PEI Programs to purchase gift cards in alignment with the scope of work to motivate positive behavior, participation, and involvement. This item is countywide.
ALTERNATIVE ACTION(S):
There are no viable alternative actions. Should your Board not approve the recommended actions, the Department will not be able to accept the program specific CDPH funds, resulting in a potential cumulative loss of staff funding for 36.25 Full-Time Equivalent (FTE), which represents more than 10% of the current staffing allocation for the Department. This would result in a critical reduction of program services, including 26 FTE in the MCAH program, 8.25 FTE in the BIH program, and 2 FTE in the PEI program. The Department meets local match requirements outlined in the proposed Agreement through other revenue agreements. If the proposed Agreement is not approved, these other revenue agreements would fall out of compliance, requiring the Department to negotiate with the respective funding agencies to determine whether continued funding would be supported.
This funding source from CDPH also supports subcontracted programs operated by Central California Faculty Medical Group, Centro La Familia Advocacy Services, Central Valley Children Services Network, Exceptional Parents Unlimited, and Fresno Economic Opportunities Commission (EOC), with approximately 12.19 FTE staff funded under these subcontracted programs. These subcontracts will need to be cancelled should your Board not approve the recommended actions.
The MCAH, BIH, and PEI programs are the only public health nursing programs focusing on preventing preterm births and decreasing maternal and infant mortality rates in the community.
RETROACTIVE AGREEMENT:
The recommended agreement is retroactive to July 1, 2026. The MCAH and BIH programs have been CDPH supported programs for over three decades. The process for the allocation requires the submittal of the Agreement Funding Application (AFA). The Department received the CDPH MCAH, BIH, and PEI Fiscal Year (FY) 2026-29 AFA on April 13, 2026. The AFA requires CDPH’s pre-approval of the budgeted amounts and submitted documents before the item can be presented to your Board for approval. The Department received CDPH’s pre-approval on September 15, 2026, and is submitting this item in accordance with agenda item processing timelines.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended actions. CDPH approved a non-competitive allocation ($16,656,034) to the County for the MCAH, BIH, and PEI programs for FY 2026-29 but required submittal of program budgets for each of the years of the agreement. The breakdown of each program’s budget for each of the year is as follows:
FY 2026-27
• MCAH $3,235,599 (Federal Title XIX $2,806,001, Federal Title V $422,226, Sudden Infant Death Syndrome $7,372)
• BIH $1,479,846 (Federal Title XIX $465,671, Federal Title V $150,627, State General Fund $863,548)
• PEI $737,807 (Federal Title XIX $142,163, State General Fund $595,644)
FY 2027-28
• MCAH $3,325,224 (Federal Title XIX $2,895,626, Federal Title V $422,226, Sudden Infant Death Syndrome $7,372)
• BIH $1,493,816 (Federal Title XIX $479,641, Federal Title V $150,627, State General Fund $863,548)
• PEI $740,930 (Federal Title XIX $145,286, State General Fund $595,644)
FY 2028-29
• MCAH $3,390,117 (Federal Title XIX $2,960,519, Federal Title V $422,226, Sudden Infant Death Syndrome $7,372)
• BIH $1,508,205 (Federal Title XIX $494,030, Federal Title V $150,627, State General Fund $863,548)
• PEI $744,490 (Federal Title XIX $148,846, State General Fund $595,644)
For FY 2026-27, MCAH uses local funding ($4,115,955) including funding from various partner agencies as a local match to draw down Federal Financial Participation (FFP) Title XIX funds which includes funding from:
• Children and Families Commission of Fresno County ($1,500,000);
• Fresno County Superintendent of Schools ($300,000);
• Department of Behavioral Health ($324,179); and
• Health Realignment ($1,991,776)
For FY 2027-28 and 2028-29, the local funding from various partner agencies that will be used as a local match to draw down FFP Title XIX funds will be recalculated during the budget change requests.
All FY 2026-27 program budgets allow the Department’s indirect cost rate of 22.85%. Sufficient appropriations and estimated revenues are included in the Department’s Org 5620 FY 2026-27 Adopted Budget and will be included in future budget requests.
DISCUSSION:
For over three decades, CDPH funding continues to support the Department’s MCAH and BIH programs in providing outreach, home visitation, health education and linkage to community resources for women and their families. Some of these programs include Nurse-Family Partnership (NFP), Sudden-Infant Death Syndrome/Fetal-Infant Mortality Review (FIMR), Child Care Health Linkages (CCHL), Nurse Liaison (NL), Public Health Nursing Program (PHNP), Comprehensive Perinatal Services Program (CPSP), and Community Health Teams (CHT). FIMR funding was awarded to only two counties in the State due to the County of Fresno having one of the highest rates of children in poverty and highest rates of infant mortality. The recommended actions will accept continued funding for staff salaries, benefits, operational expenses, subcontracts, and indirect costs for the MCAH and BIH programs to continue their work towards:
• reducing infant mortality;
• improving the health and safety of children attending childcare programs;
• reducing maternal morbidity and mortality;
• supporting the physical and cognitive development of children;
• promoting exclusive breastfeeding; and
• optimizing the health and well-being of the client populations across their life span.
In FY 2025-26, these programs continued to provide a wide range of services to the community. The NL program provided case management services to 328 pregnant/parenting teens, high-risk children, and their families. The Children and Families Commission of Fresno County (First 5), NFP program in partnership with the Department, served 41 women, helped 98% of enrolled women initiate breastfeeding after birth, and completed 67 screenings for perinatal mood and anxiety disorders. The CHT program provided intensive home visitation services using research-based models and curriculum to 206 families, with 204 children ages 0-5. The CCHL program provided health/safety consultation and training to 607 childcare providers. Ongoing grief support was provided to 2 SIDS families. The FIMR program established the Case Review Team (CRT) consisting of community providers, advocates, physicians, and nurses from local hospitals and neonatal intensive care units. There were 9 CRT meetings held, and 28 FIMR cases reviewed in the last fiscal year. The BIH program served 70 women through the Group/Life Planning Model and 33 women served through the Case Management Only Model.
In 2024, the County's infant mortality rate for African American infants (19.1 per 1,000 live births) was 3.5 times higher than the County's overall rate of 5.5 and 4.7 times higher than the statewide rate of 4.1. While the Department's BIH program continues to work toward reducing African American infant mortality, gaps in services still exist. CDPH continues to award funding to 11 local county health departments with BIH programs to establish the PEI and support implementation of perinatal health interventions to reduce disparities in infant mortality rates and fill gaps in current services.
The PEI funding will help continue PEI activities and collaboration including, but not limited to:
• Partnering with community-based organizations (CBOs) to implement legislated PEI interventions, including fatherhood services, doula services, and pre/interconception education;
• Overseeing administration of the PEI to ensure program implementation, planning, evaluation, and fiscal management in compliance with CDPH-MCAH guidelines;
• Continuing to support a local Perinatal Health Equity Community Advisory Board in its efforts to engage local leaders and stakeholders in discussing needs and opportunities to reduce African American infant mortality; and
• Conducting a public health awareness campaign to inform the community about African American birth outcome inequities and the drivers of these inequities.
The MCAH, BIH, and PEI funds may be used for client support materials items to motivate positive behavior, participation, and involvement. These funds have been used in the past to purchase items determined as necessary for risk reduction after an assessment has been completed for enrolled participants. Purchased items include but are not limited to: cabinet locks, plug covers, pack ‘n plays, cribs, breast pumps, diapers, school readiness materials, and gift cards. In FY 2025-26, a total of 464 gift cards were distributed across the three programs to enrolled participants. Gift cards purchased and distributed to support programmatic activities are alcohol, tobacco, and firearm (ATF) restricted from County approved vendors. Additionally, the programs have protocols in place to track and distribute in accordance with funder requirements and are reviewed quarterly by the Public Health Nursing Licensed Division Manager.
The recommended actions are based on the submitted AFA, budgets, and scope of work, as reviewed and approved by CDPH. The recommended agreement deviates from the County’s standard indemnification language and requires the County (or County’s contractors receiving this funding) to indemnify the State in the event of any exceptions (i.e., not following procedures or maintenance of documents) found as a result of a federal audit, in connection with the performance of the agreement.
CDPH will issue the award letter for each program once the AFA is approved.
REFERENCE MATERIAL:
BAI #71, December 9, 2025
BAI #60, December 3, 2024
BAI #45, October 24, 2023
BAI #69, June 20, 2023
BAI #33, November 8, 2022
BAI #49, November 16, 2021
BAI #36, November 2, 2021
BAI #36, November 3, 2020
BAI #48, May 26, 2020
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - FY 2026-29 Agreement Funding Application with CDPH
CAO ANALYST:
Ron Alexander