EL Dorado County Grand Jury 2020-2021 Dorado Count*

Conclusions 2

• CL1 Page 54
  While there have been steps taken by the State's Department of Health Care Services to relax the codes and timeframes that control the reversion of funds, unexpended MHSA funds are still subject to be returned back to the State, unlike most other County programs, where funds not spent during a budget year are returned to the County's General Fund. The State then redistributes unspent funds to all 58 counties. The County 2018-2019 annual plan update has a Reversion Reallocation Expenditure Plan, which calls for funds subject to reversion to be given priority for expenditure. The County's new three year Program Plan (Fiscal Years 2020-21 to 2022-23) also includes a Reversion Reallocation Expenditure Plan. Additionally, the annual update (Fiscal Year 2019-20) calls for Community Services and Support funds identified during the fiscal year that are at risk of reversion be transferred to the Reserve account. As was the case with the previous Grand Jury, we interviewed individuals with the most knowledge of MHSA funds. This time around, however, these key County administrators indicated that there have been some recent changes that reduce the risk of the County having funds returned to the State. While the underlying budget philosophy in the County has not changed, we can see that progress has been made, including: Traffic Days ton Taking steps to start the contract process sooner, including earlier approval by the Board ٠ of Supervisors, so that the contracted services are available when they are needed. Assuring that funds are used in a "First In, First Out" sequence, so as to minimize the . possibility of losing funds. While we've noted these successes since our last MHSA report a few years ago, both County and Behavioral Health Division administrators need to strongly consider possible strategies to assist with the hiring and retention of MHSA staff, especially clinicians. One thing that has not changed since our last report is the extremely high vacancy rate in the program, and we don't see that improving without a significant change to how our County administrators deal with both the high turnover and the difficulty in recruiting. Finally, it should be noted that the Grand Jury believes that the risk to the County by "over- hiring" staff for the MHSA program is minimal, as historically, the program has never been fully staffed, nor have they expended anywhere close to the amount budgeted for program personnel. This could be accomplished by the use of Recruitment Allowance Positions. In addition, according to high-level MHSA staff the Grand Jury interviewed, the Prudent Reserve from MHSA funding may be used to cover potential personnel cost overages, although such use would probably require the prior approval of the State's MHSOAC. It has also been reported to us that counties in our area-including Sacramento County, are already using this budgeting strategy. IVII. in the same of the entire the state of the same the same state of the 9 Mental Health Services Act Fund Spending 6/30/2021 El Dorado County 2020-2021 Grand Jury
• CL2 Page 60
  Emergency medical response in CSA 7 is a system of which the County can be proud. The firefighters who provide these services are true professionals. The nine FDs in CSA 7 work well together as one entity to serve the public. However, the disparity in FDs (see Grand Jury fire protection reports from 2017-2018, 2018-2019 and 2019-2020) can cause a varying level of initial response. The current ambulance service is producing an annual financial surplus. The County and JPA can make a good service even better.

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