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Home My WebLink AboutAgreement A-23-554 FY 2023-24 HCPCFC Plan and Budget.pdf Agreement No. 23-554 Pz,� H C S CALIFORNIA DEPARTMENT OF HEALTH CARE SERVICES Michelle 8aass I Director JULY 1, 2023 HCPCFC PROGRAM LETTER: 23-01 TO: CHILD HEALTH & DISABILITY PREVENTION PROGRAM DIRECTORS, DEPUTY DIRECTORS, HEALTHCARE PROGRAM FOR CHILDREN IN FOSTER CARE ADMINISTRATORS, MEDICAL CONSULTANTS, AND DEPARTMENT OF HEALTH CARE SERVICES STAFF SUBJECT: HEALTH CARE PROGRAM FOR CHILDREN IN FOSTER CARE FISCAL YEAR 2023-2024 ALLOCATION The purpose of this letter is to provide Health Care Programs for Children in Foster Care (HCPCFC) with their Fiscal Year (FY) 2023-2024 allocation. This letter serves as each local program's approved state HCPCFC budget and enables each local program to use this letter to develop its budget. Budget approval letters will not be issued. Detailed budget information may be found in the Integrated Systems of Care Division (ISCD) Plan and Fiscal Guidelines (PFG). Acceptance of funds constitutes an agreement that the receiving local program and its agency will comply with all federal and state requirements pertaining to the HCPCFC program and adhere to all applicable policies and procedures set forth by the Department of Social Services and the Department of Health Care Services. Periodically, the federal program responsible for oversight of the Medicaid program and related state administrative expenditures, will conduct programmatic audits. Finding of a federal audit exception and subsequent liability for repayment of federal Medicaid funds related to the HCPCFC program audit exception, are the exclusive and sole responsibility of each local program. Each local program remains responsible for overseeing and tracking its expenditures. An audit file must be maintained. At a minimum this audit file should include: » Documentation of required time studies, performed during one or more representative months of the fiscal quarter for each budgeted position claimed under Federal Financial Participation (FFP). >> Documentation in support of claimed expenditures. >> Documentation to demonstrate compliance with all federal and state requirements pertaining to the HCPCFC program, and adherence to all California Department of Health Care Services State of California Integrated Systems of Care Division Gavin Newsom,Governor '> 1501 Capitol Ave I Sacramento, CA 1 95899-7437 MS 4502 1 Phone(916)449-5000 1 www,dhcs.ca.gov California Health and Human Services Agency July 1, 2023 HCPCFC PROGRAM LETTER 23-01: FISCAL YEAR 2023-2024 ALLOCATION Page 2 of 9 applicable policies and procedures set forth by the Department of Social Services and the Department of Health Care Services. Counties should maintain and be prepared to produce the audit file to State and Federal entities within seven (7) calendar days of a request. Budget Reporting Instructions Utilize the HCPCFC Budget Workbook. Budget workbooks may be found in the Templates section of the ISCD Budget Portal' and by requested to HCPCFC@dhcs.ca.gov. Questions regarding the ISCD Budget Portal may be directed to ISCDFiscal@dhcs.ca.gov. >> Sign electronically using Adobe Acrobat Pro DC Self-signed with Digital ID function or DocuSign.3 If access to either of these options is not available, scanned signature will be accepted, with the original kept in the local audit file. Electronic signature will be required in FY 2024-25. Submit electronically to the ISCD Budget Portal. Submit only two documents to the ISCD Budget Portal: o One Excel version of the HCPCFC Budget Workbook and o One signed PDF version of the HCPCFC Budget Workbook Submit only the information requested in the HCPCFC Budget Workbook. Be prepared to provide ISCD with additional documentation to demonstrate compliance with program requirements, upon request. _> Submit by September 15, 2023. If all necessary signatures cannot be obtained by this date, submit completed excel workbooks by the deadline and contact HCPCFC@dhcs.ca.gov to request an extension for submission of required signatures. Child Health and Disability Prevention (CHDP) Transition ' https://iscdbudget.cloudapps.dhcs.ca.gov/ 2 https://helpx.adobe.com/acrobat/using/digital-ids.html 3 https://support.docusign.com/s/articles/How-do-I-sign-a-DocuSign-document-Basic- Signinq?language=en US&rsc 301 July 1, 2023 HCPCFC PROGRAM LETTER 23-01: FISCAL YEAR 2023-2024 ALLOCATION Page 3 of 9 As announced in CHDP Program Letter and Provider Notices 22-024 and 22-06,5 the CHDP program will be discontinued effective July 1, 2024. Information regarding the transition, including opportunities for stakeholder engagement, can be found on the CHDP Transition webpage.6 Alternative resources and further information regarding the transition of specific activities to existing delivery systems will be integrated into the CHDP Program webpage'- and the HCPCFC Program webpage8 in the coming months. Contact Information Questions regarding the ISCD Budget Portal and expenditure invoicing may be directed to: ISCDFiscal@dhcs.ca.gov. All other questions may be directed to the central program inbox: HCPCFC@dhcs.ca.gov. Sincerely, ORIGINAL SIGNED BY CORTNEY MASLYN Cortney Maslyn, Chief Integrated Systems of Care Division Department of Health Care Services Attachments: 1. FY 2023-24 HCPCFC Allocation Tables A. Base Allocation B. Psychotropic Medication Monitoring & Oversight C. Caseload Relief 4 https://www dhcs.ca gov/services/chdp/Documents/CHDP-Provider-Information-Notice-22-02.pdf 5 https://www.dhcs.ca.gov/services/chdp/Documents/CHDP-Provider-Info-Notice-22-06.pdf 6 https://www.dhcs.ca.qov/services/chdp/Pages/CHDP-Transition.aspx https://www.dhcs.ca.gov/services/chdp 8 https://www.dhcs.ca.gov/services/hcpcfc July 1, 2023 HCPCFC PROGRAM LETTER 23-01: FISCAL YEAR 2023-2024 ALLOCATION Page 4 of 9 Attachment 1A: Health Care Program For Children in Foster Care Base Allocation (07/01/2023 through 06/30/2024) County/City State General Funds Federal Funds Total Funds Alameda $177,822 $533,467 $711,289 Alpine $3,000 $9,000 $12,000 Amador $8,244 $24,733 $32,978 Butte $69,351 $208,052 $277,403 Calaveras $11,801 $35,403 $47,204 Colusa $5,820 $17,459 $23,279 Contra Costa $98,126 $294,377 $392,502 Del Norte $17,459 $52,377 $69,836 El Dorado $19,884 $59,651 $79,535 Fresno $408,991 $1,226,973 $1,635,964 Glenn $7,598 $22,794 $30,391 Humboldt $55,772 $167,315 $223,086 Imperial $57,873 $173,619 $231,492 In o $3,000 $9,000 $12,000 Kern $304,076 $912,228 $1,216,304 Kings $54,155 $162,465 $216,620 Lake $13,902 $41,707 $55,610 Lassen $10,346 $31,038 $41,384 Los Angeles $2,970,116 $8,910,347 $11,880,463 Madera $42,192 $126,577 $168,769 Marin $13,902 $41,707 $55,610 Mariposa $3,000 $9,000 $12,000 Mendocino $34,918 $104,753 $139,671 Merced $89,396 $268,188 $357,584 Modoc $2,425 $7,275 $9,699 Mono $3,000 $9,000 $12,000 Monterey $33,625 $100,874 $134,498 Napa $15,519 $46,557 $62,076 Nevada $7,436 $22,309 $29,745 Orange $400,423 $1,201,270 $1,601,693 Placer $29,260 $87,780 $117,039 Plumas $5,658 $16,974 $22,632 Riverside $509,218 $1,527,654 $2,036,873 Sacramento $254,771 $764,312 $1,019,083 San Benito $5,658 $16,974 $22,632 San Bernardino $862,761 $2,588,283 $3,451,044 San Diego $336,731 $1,010,192 $1,346,922 July 1, 2023 HCPCFC PROGRAM LETTER 23-01: FISCAL YEAR 2023-2024 ALLOCATION Page 5 of 9 Attachment 1A: Health Care Program For Children in Foster Care Base Allocation (07/01/2023 through 06/30/2024) County/City,, ,State General Fundsi, Federal Funds Total Funds San Francisco $1001227 $300,681 $400,908 San Joaquin $193,826 $581,479 $775,305 San Luis Obispo $41,546 $124,637 $166,183 San Mateo $21,985 $65,956 $87,941 Santa Barbara $65,309 $195,928 $261,237 Santa Clara $93,114 $279,343 $372,457 Santa Cruz $24,572 $73,715 $98,287 Shasta $64,824 $194,473 $259,297 Sierra $3,000 $9,000 $12,000 Siski ou $10,508 $31,523 $42,031 Solano $63,693 $191,078 $254,771 Sonoma $82,283 $246,850 $329,133 Stanislaus $98,934 $296,801 $395,735 Sutter $14,064 $42,192 $56,256 Tehama $18,591 $55,772 $74,362 Trinity $3,071 $9,214 $12,286 Tulare $145,491 $436,473 $581,964 Tuolumne $12,609 $37,828 $50,437 Ventura $77,272 $231,815 $309,087 Yolo $53,832 $161,495 $215,327 Yuba $28,452 $85,355 $113,806 City of Berkeley $6,143 $18,429 $24,572 $8,170,5736: July 1, 2023 HCPCFC PROGRAM LETTER 23-01: FISCAL YEAR 2023-2024 ALLOCATION Page 6 of 9 Attachment 1 B: Health Care Program For Children in Foster Care Psychotropic Medication Monitoring and Oversight Allocation (07/01/2023 through 06/30/2024) State General County/City Funds Federal Funds Total Funds Alameda $40,795 $122,386 $163,181 Alpine $3,659 $10,975 $14,634 Amador $3,659 $10,975 $14,634 Butte $18,293 $54,878 $73,171 Calaveras $3,659 $10,975 $14,634 Colusa $3,659 $10,975 $14,634 Contra Costa $36,585 $109,756 $146,341 Del Norte $3,659 $10,975 $14,634 El Dorado $10,976 $32,926 $43,902 Fresno $54,878 $164,634 $219,512 Glenn $3,659 $10,975 $14,634 Humboldt $7,317 $21,951 $29,268 Imperial $14,634 $43,903 $58,537 Inyo $3,659 $10,975 $14,634 Kern $40,244 $120,732 $160,976 Kings $7,317 $21,951 $29,268 Lake $7,317 $21,951 $29,268 Lassen $3,659 $10,975 $14,634 Los Angeles $526,829 $1,580,488 $2,107,317 Madera $3,659 $10,975 $14,634 Marin $3,659 $10,975 $14,634 Mariposa $3,659 $10,975 $14,634 Mendocino $10,976 $32,926 $43,902 Merced $10,976 $32,926 $43,902 Modoc $3,659 $10,975 $14,634 Mono $3,659 $10,975 $14,634 Monterey $14,634 $43,903 $58,537 Napa $3,659 $10,975 $14,634 Nevada $3,659 $10,975 $14,634 Orange $47,561 $142,683 $190,244 Placer $7,317 $21,951 $29,268 Plumas $3,659 $10,975 $14,634 Riverside $102,439 $307,317 $409,756 Sacramento $73,171 $219,512 $292,683 San Benito $3,659 $10,975 $14,634 San Bernardino $142,683 $428,049 $570,732 July 1, 2023 HCPCFC PROGRAM LETTER 23-01: FISCAL YEAR 2023-2024 ALLOCATION Page 7 of 9 Attachment 1 B: Health Care Program For Children in Foster Care Psychotropic Medication Monitoring and Oversight Allocation (07/01/2023 through 06/30/2024) State General County/City Funds Federal Funds Total Funds San Diego $80,488 $241,463 $321,951 San Francisco $25,610 $76,829 $102,439 San Joaquin $51,220 $153,658 $204,878 San Luis Obispo $14,634 $43,903 $58,537 San Mateo $10,976 $32,926 $43,902 Santa Barbara $14,634 $43,903 $58,537 Santa Clara $36,585 $109,756 $146,341 Santa Cruz $7,317 $21,951 $29,268 Shasta $14,634 $43,903 $58,537 Sierra $3,658 $10,976 $14,634 Siski ou $3,658 $10,976 $14,634 Solano $10,975 $32,927 $43,902 Sonoma $18,292 $54,879 $73,171 Stanislaus $29,267 $87,806 $117,073 Sutter $7,316 $21,952 $29,268 Tehama $3,658 $10,976 $14,634 Trinity $3,658 $10,976 $14,634 Tulare $21,951 $65,855 $87,806 Tuolumne $3,658 $10,977 $14,635 Ventura $25,609 $76,831 $102,440 Yolo $14,634 $43,904 $58,538 Yuba $7,316 $21,953 $29,269 Cit of Berkele $3,107 1 $9,322 1 $12,429 July 1, 2023 HCPCFC PROGRAM LETTER 23-01: FISCAL YEAR 2023-2024 ALLOCATION Page 8 of 9 Attachment 1C: Health Care Program For Children in Foster Care Caseload Relief Allocation (07/01/2023 through 06/30/2024) County/City State General Funds Federal Funds Total Funds Alameda $97,126 $291,374 $388,500 Alpine $0 $0 $0 Amador $3,996 $11,989 $15,985 Butte $36,351 $109,051 $145,402 Calaveras $5,836 $17,509 $23,345 Colusa $3,172 $9,516 $12,688 Contra Costa $67,880 $203,639 $271,519 Del Norte $4,821 $14,464 $19,285 El Dorado $19,095 $57,285 $76,380 Fresno $133,095 $399,283 $532,378 Glenn $5,075 $15,226 $20,301 Humboldt $23,346 $70,036 $93,382 Imperial $28,611 $85,832 $114,443 In o $1,161 $3,483 $4,644 Kern $109,940 $329,818 $439,758 Kings $24,171 $72,511 $96,682 Lake $10,341 $31,021 $41,362 Lassen $4,314 $12,942 $17,256 Los Angeles $1,389,880 $4,169,636 $5,559,516 Madera $21,125 $63,376 $84,501 Marin $5,963 $17,890 $23,853 Mariposa $1,903 $5,710 $7,613 Mendocino $17,318 $51,956 $69,274 Merced $33,495 $100,487 $133,982 Modoc $963 $2,889 $3,852 Mono $0 $0 $0 Monterey $27,659 $82,978 $110,637 Napa $8,310 $24,932 $33,242 Nevada $3,996 $11,989 $15,985 Orange $150,604 $451,810 $602,414 July 1, 2023 HCPCFC PROGRAM LETTER 23-01: FISCAL YEAR 2023-2024 ALLOCATION Page 9 of 9 Attachment 1C: Health Care Program For Children in Foster Care Caseload Relief Allocation 07/01/2023 through 06/30/2024 County1City:.,;,�,,'1 State General Funds Federal Funds Total Funds Placer $14,211 $42,632 $56,843 Plumas $3,172 $9,516 $12,688 Riverside $219,497 $658,493 $877,990 Sacramento $151,429 $454,285 $605,714 San Benito $3,679 $11,038 $14,717 San Bernardino $381,013 $1,143,039 $1,524,052 San Diego $173,441 $520,324 $693,765 San Francisco $57,856 $173,568 $231,424 San Joaquin $98,139 $294,419 $392,558 San Luis Obispo $26,328 $78,981 $105,309 San Mateo $18,206 $54,621 $72,827 Santa Barbara $28,357 $85,071 $113,428 Santa Clara $74,668 $224,002 $298,670 Santa Cruz $17,382 $52,147 $69,529 Shasta $28,166 $84,500 $112,666 Sierra $0 $0 $0 Siski ou $6,725 $20,174 $26,899 Solano $27,469 $82,407 $109,876 Sonoma $33,433 $100,297 $133,730 Stanislaus $48,214 $144,641 $192,855 Sutter $11,102 $33,305 $44,407 Tehama $13,830 $41,489 $55,319 Trinity $3,299 $9,896 $13,195 Tulare $67,371 $202,115 $269,486 Tuolumne $6,660 $19,983 $26,643 Ventura $53,606 $160,818 $214,424 Yolo $27,216 $81,647 $108,863 Yuba $13,701 $41,109 $54,810 City of Berkeley $2,283 $6,851 $9,134 Health Care Program for Children in Foster Care Plan and Budget Reporting Checklist Page Number 1. HCPCFC Plan and Budget Reporting Checklist 1 2. HCPCFC Certification Statement 2 3. HCPCFC Organizational Chart Retain Locally 4. HCPCFC MOU with Local Child Welfare/Social Services N/A 5. HCPCFC Probation IA N/A 6. If Applicable: a. Contractor Equipment Purchased with DHCS Funds Form (DHCS1203) N/A b. Inventory/Disposition of DHCS Funded Equipment Form (DHCS1204) N/A c. Property Survey Report Form (STD 152) N/A 7. HCPCFC Plan and Budget Reporting Spreadsheet a. Agency Information Sheet 3 b. Memorandum of Understanding and Interagency Agreement 4 List c. HCPCFC Incumbent List 5 d. HCPCFC Budgets i. Base 6 — Summary and Worksheet 7 — Budget Narrative ii. Psychotropic Medication Monitoring and Oversight 8 — Summary and Worksheet g — Budget Narrative iii. Caseload Relief 10 — Summary and Worksheet 11 — Budget Narrative iv. Optional County/City- Federal Match N/A — Summary and Worksheet N/A — Budget Narrative E)HCS State of California—Health and Human Services Agency Department of Health Care Services '414 MICHELLE BAAM GAVIN NEMOM DRECTOR GOVERNOR Health Care Program for Children in Foster Care Certification Statement County/City: Fresno Fiscal Year: 2023-24 1 certify that the Health Care Program for Children in Foster Care (HCPCFC) will comply with all applicable state and federal and state laws and regulations, including all federal laws and regulations governing recipients of federal funds granted to states for medical assistance pursuant to Title XIX of the Social Security Act(42 U.S.C. Section 1396 et seq.). I further certify that the HCPCFC will comply with all rules promulgated by DHCS pursuant to these authorities, including the Integrated Systems of Care Plan and Fiscal Guidelines Manual, I further agree that this HCPCFC may be subject to sanctions or other remedies if this HCPCFC violates any of the above. ,rQruL ,L.rt,2 7/28/23 Signature of HCPCFC Director/County Authorized Date Signed Representative S' ature of, or Health Officer Date Signed Signature and Title of Other—Optional Date Signed I certify that this plan has been approved by the local governing body. 54 to /Old 3 Sig(n) f L al Governing Body Chairperson Date Signed ATTEST: BERNICE E.SEIDEL Clerk of the Board of Supervisors County of Fresno,State of California By_ g Deputy Systems of Care Division 1515 K Street,Suite 400,Sacramento,CA 95814 P.O. Box 997413,MS 8100 Sacramento,CA 95899-7413 (918)327-1400 Internet Address:www.dhcs.ca.gov IIII111�11111�� DHCS State of California—Health and Human Services Agency w a 4Rp Department of Health Care Services '- ;;� �`+ Health Care Program for Children in Foster Care MICHELLEBAASS Agency Information GAVINNEWSOM DIRECTOR GOVERNOR County/City: IFresno I Fiscal Year: 2023-24 Official Agency Street Address:1221 Fulton Street Health Officer: Rais Vohra, MD (interim) City: Fresno Local HCPCFC Zip Code: 93721 Central Inbox: Parent Agency Director (if applicable) Name: David Luchini, Director Street Address: 1221 Fulton Street Phone: City: Fresno Email: Zip Code: 93721 Authorized HCPCFC Program Administrative Representative Name: Ankara Lee Street Address: 380 W.Ashlan Phone: 559-600-6591 City: Clovis Email: alee@fresnocountyca.gov Zip Code: 93612 Clerk of the Board of Supervisors or City Council Name: Bernice Seidel Street Address: 2281 Tulare St, 3rd Floor Phone: 559-600-6592 City: Fresno Email: bseidel@fresnocountyca.gov Zip Code: 93721 Director of Social Services Agency Name: Sanja Bugay Street Address: 205 W Pontiac Way, Bldg 2 Phone: 559-600-2301 City: Clovis Email: sbugay@fresnocountyca.gov Zip Code: 93612 Chief Probation Officer Name: Kirk Haynes Street Address: 3333 E.American Ave, STE B Phone: 559-600-1298 City: Fresno Email: khaynes Zip Code: 93725 /may ) / kd >} \ -- S co ca � ) 2 / U \ Q 2 a 2 / k \ / � . .> \ k f � ƒy o �41 k / k / \ - 2 z e e E ? / \ \ m k § \ ¢ 3 @ q A Q o .— 2 � a » D ° \c . § (D / L) � cu cc » / \ Co E 7 \ \ \ \ 5v CL \ R \ 2 = @cu 2 c 2 0 � 4a) U o \ E m § § / } § Q \ \ 5 \ t a \ \ � e / \ 2 � a \ k ) CDCD Q) \ } \ _ R Q { E § ƒ ) < \ j u&Lcn k } § { \ LLJ U uj � \ § § / v / / m # r c a c m 9 a / '. / \ a \ ` � % ° m \ \ / \ LL ±•ƒ. 7 0 = - $ k / / 2 y 3 \ # IL \ « / .( .7 / .. ƒ ƒ > \ K / A ' k d G .Q y � \ 0 9 ƒ S / d / \ y y � / & / 3 \ § \ j E ® ƒ \ k 0 U) \ ) § k � / r ITS wo g Cl) � � 7 CDA A0 E f k $ \ k f t cu a $ % a m 2 c cc Q ® & o n % % m < cn k � ® 3 � � $ v § / / it £ / ƒ ' � k % ) \ E w CO � \ � m CU § k § § � 2 ) / } ƒ ƒ ƒ ƒ ƒ ƒ ƒ ƒ e o u \ a 2 // _= 3 « ° 7 \\ \ ¢ Z \ - dco ca CL / C ® / in m ■ t � 0 k \ k 3 / m \ ® ICU - ~ r - - - ° C ° / / k \ k \ / 2 / / / (p J / / a / C') ƒ / / .2 / E 3 = $ \ 3 $ / $ $ ƒ / \ / c E E a 0 2 a & s a :I-- / � Q) \ C� QT CO \ [ _ ƒ � \ 2 ƒ \ 3 G 3 = m G w :o ƒ » 8 3 2 R § m m c s / \ ) \_ § / / E m § X � \ r = $ / / w / 2 / / \ % m m "I. r c a c c y DHCS State of California-Health and Human Services Agency 1ROO Department of Health Care Services I Health Care Program for Children in Foster Care MICHELLE BAASS Budget Worksheet GAVIN NEWSOM DIRECTOR GOVERNOR StatelFederal Funding Source: I Base County/City Name: Fresno IFIscal Year: 2023-24 Column 1A 1B 1 2A 2 3A 3 Category/Line Item Total Base FTE Enhanced FTE Enhanced Non-Enhanced Non-Enhanced % Annual Salary Total Budget % (25/75) FTE% (50/50) I.Personnel Expenses # Name 1 Ankaa Lee(SupervisigPubk,HesihNume) 75% $132,522 $99,392 75.00% $74,544 25.00% $24,848 2 Samantha Campbell(Public HealO 100% $89,970 $89,970 75.00% $67,478 25.00% $22,493 3 Sally Lopez(Public Health Nurse 1 100% $116.685 $116,685 75.00% $87,514 25.00% $29,171 4 Gursimran Deal(Public Health Nurse 1) 100% $89,970 $89,970 75.00% $67,478 25.00% $22,493 5 Vacant(Public Health Nurse 1) 50% $85,680 $42,840 75.00% $32,130 25.00% $10,710 6 Pa Xiong(Office Assistant II) 100% $43,626 $43,626 0.00% $0 100.00% $43,626 7 $0 $0 100% $0 8 $0 $0 100% $0 9 $0 $0 100% $0 10 $0 $0 100% $0 (insert additional rows as needed) $0 1 $0 100% $0 Total PHN FTE% 500% 375.00% 125.00% Total Direct Support Staff FTE% 100% 75.00% 25.00% Net Salaries and Wages $482,483 $329,142 $153,340 Staff Benefits(Specify%) 72.496% $349,782 $238,616 $111,166 I.Total Personnel Expenses $832,265 $567,758 $264,506 11.Operating Expenses 1. Travel $12,000 75.00% $9,000 25.00% $3,000 2. Training $12,000 75.00% $9,000 25.00% $3,000 11.Total Operating Expenses $24,000 $18,000 $6,000 III.Total Capital Expenses IV.Indirect Expenses 1. jlntemal(Specify%) 1 18.314% $156,816 $156,816 IV.Total Indirect Expenses $156,816 $156,816 V.Total Other Expenses Budget Grand Total $1,013,081 $585,758 $427,322 IChashua Lor I Staff Analyst 11 I 7/28/2023 chlor@fresnocounlyca.gov Pre ared 8 : Sin Print Title Date Email p :fu Z" g (Ankara Lee I Supervising Public Health Nurse I 7128/2023 I alee@fresnocountyca.gov Authorized HCPCFC Sign Print Title Date Email Program Representative: Budget Summary tables can be found on the"Summary Tables"sheet of this workbook. DHCS State of California—Health and Human Services Agency4Rp Department of Health Care Services Health Care Program for Children in Foster Care MICHELLE BAASS Budget Narrative GAVIN NEWSOM DIRECTOR GOVERNOR State/Federal Funding Source: Base County/City Name Fresno I Fiscal Year 2023-24 I. Personnel Expenses Identify and Explain Any Changes in Personnel/Personnel Expenses Salary and Benefits for 6 positions,total of 5.25 FTE. Benefits calculated with estimated total benefits rate for the positions. Includes retirement, health insurance,OASDI, Unemployment Insurance,and Benefits II. Operating Expenses Identify and Explain All Operating Expense Line Items Private auto mileage reimbursement at$0.655/mile for program staff to travel to Travel: complete program activities and attend State-sponsored meetings, including regional Registration costs for PHNs to attend State recommended training and workshops to Training: maintain professional competence and gain program specific skills. Also includes Ill. Capital Expenses cannot be included in this budget IV. Indirect Expenses Indirect External Expenses cannot be included in this budget Identify and Explain All Indirect Expense Line Items Fresno County Department of Public Health's indirect rate is 18.314%of personnel costs Internal: approved for use by Fresno County's Auditor Controller/Treasurer-Tax Collector. V. Other Expenses cannot be included in this budget Chashua Lof 0 45135 Prepared By: Sign Print Title Date Email 49,0z, Z Ankara Lee 0 7f28f23 45135 alee@fresnocountyca.gov Authorized HCPCFC Program Representative:Sign Print Title Date Email ®HCS Stale of California—Health and Human Services Agency Department of Health Care Services ' Health Care Program for Children in Foster Care MICHELLE BRASS Budget Worksheet GAVIN NEWSOM DIRECTOR GOVERNOR State/Federal Funding Source: I Psychotropic Medication Monitoring&Oversight County/City Name: Fresno I Fiscal Year: 2023-24 Column 1A 1B 1 2A 2 3A 3 Category/Line Item Total PMM&0 Enhanced FTE Enhanced Non-Enhanced Non-Enhanced FrE% Annual Salary Total Budget % (25/75) FTE (50/50) I.Personnel Expenses # Name 1 Public Health Nurse(Michael Hughes) 100% $116,685 $116,685 75.00% $87,514 25.00% $29,171 2 $0 $0 100% $0 3 $0 $0 100% $0 4 $0 $0 100% $0 5 $0 $0 100% $0 6 $0 $0 1 100% $0 7 $0 $0 100% 1 $0 8 $0 $0 100% $0 9 $0 $0 100% $0 10 $0 $0 100% $0 (insert additional lines as needed) $0 $0 100% $0 Total PHN FfE% 100% 75.00% 25.00% Total Direct Support Staff FTE% 100% 75.00% 25.00% Net Salaries and Wages $116,685 $87,514 $29,171 Staff Benefits(Specify%) 75.444% $88,031 $66,024 $22,008 I.Total Personnel Expenses $204,716 $153,538 $51,179 II,Operating Expenses 1. Travel $3,000 75.00% $2,250 25.00% $750 2. Training $3,000 75.00% $2,250 25.00% $750 II.Total Operating Expenses $6,000 $4,500 $1,500 III.Total Capital Expenses IV.Indirect Expenses 1. 1 Internal(Specify%) 4.175% $8,796 $8,796 IV.Total Indirect Expenses $8,796 $8,796 V.Total Other Expenses Budget Grand Total $219,512 $158,038 1 1 $61,475 —� ChashuaLor Staff Analyst ll 45135 chlor@fresnocounlyca.gov Pre ared By: Sign Print Title Dale Email 1Y 9-At- Ankara Lee Supervising Public Health Nurse 7/28/23 45135 alee@fresnocountyca.gov Authorized HCPCFC Sign Print Title Dale Email Program Representative: Budget Summary tables can be found on the"Summary Tables"sheet of this workbook. DHCS State of California—Health and Human Services Agency INP Department of Health Care Services . Health Care Program for Children in Foster Care MICHELLE BAASS Budget Narrative GAVIN NEWSOM DIRECTOR GOVERNOR StatelFederal Funding Source: Psychotropic Medication Monitoring& Oversight County/City Name Fresno I Fiscal Year 2023-24 I. Personnel Expenses Identify and Explain Any Changes in Personnel/Personnel Expenses Salary and Benefits for 1 FTE PHN. Includes retirement, health insurance,OASDI, Unemployment Insurance,and Benfefits Administration. II. Operating Expenses Identify and Explain All Operating Expense Line Items Registration costs and ancillary costs for PHN to attend State recommended training and Training: workshops to maintain professional competence and gain program specific skills. Private auto mileage reimbursement at$0.655/mile for program staff to travel to Travel: complete program activities and attend State-sponsored meetings, including regional III. Capital Expenses cannot be included in this budget IV. Indirect Expenses Indirect External Expenses cannot be included in this budget Identify and Explain All Indirect Expense Line Items Fresno County Department of Public Health's indirect rate is 18.314%of personnel costs Internal: approved for use by Fresno County's Auditor Controller/Treasurer-Tax Collector. 0 tn remain within PMO allocation. V. Other Expenses cannot be included in this budget Chashua LoI 0 45135 Prepared By: Sign Print Title Date Email A--f� .L" Ankara Lee 0 728/23 45135 Authorized HCPCFC Program Representative:Sign Print Title Date Email DHCS State of California-Health and Human Services Agency Department of Health Care Services ' IT 4RP Health Care Program for Children in Foster Care MICHELLE aAASS Budget Worksheet GAVIN NEWSOM DIRECTOR GOVERNOR State/Federal Funding Source: Caseload Relief County/City Name: Fresno Fiscal Year: 2023-24 Column 1A 1B 1 2A 2 3A 3 Cate o ILine Item Total Caseload Enhanced FTE Enhanced Non- Nan- g ry Relief FTE% Annual Salary Total Budget % (25/75) Enhanced FTE Enhanced % (50/50) 1.Personnel Expenses # Name 1 Public Health Nurse(Nestor Yalong) 100% $116,685.00 $116,685 75.00% $87,514 25.00% $29,171 2 Public Health Nurse(Vacant) 50% $85,680.00 $42,840 75.00% $32,130 25,00% $10,710 3 $0 $0 100% $0 4 $0 $0 100% $0 5 $0 $0 100% $0 6 $0 $0 100% $0 7 $0 $0 100% $0 8 $0 $0 100% $0 9 $0 $0 100% $0 10 $0 $0 100% $0 (insert additional lines as needed) $0 $0 100% 1 $0 Total PHN FTE% 2000/6 150.00% 50.00% Total Direct Support Staff FTE% 100% 75.00% 25.00% Net Salaries and Wages $159,525 $119,644 $39,881 Staff Benefits(Specify% 63.4251/6 $101,179 $75,884 $25,295 I.Total Personnel Expenses $260,704 1 1 $195,528 1 $65,176 II.Operating Expenses 1. Travel $6,000 75.00% $4,500 25.00% $1,500 2. Training $6,000 75.00% $4,500 25.00% $1,500 II.Total Operating Expenses $12,000 $9,000 $3,000 III.Total Capital Expenses IV.Indirect Expenses 1. 1 Internal(Specify%) 18,314% $49,943 $49.943 IV.Total Indirect Expenses $49,943 $49,943 V.Total Other Expenses Budget Grand Total $322,647 $204,528 $118,119 ChashuaLor StaffAnalyslll 45135 chlor@fresnocountyca.gov Prepared By: Sign Print Title Date Email ,ty 94f, Z-9Z Ankara Lee Supervising Public Health Nurse 11M21 45135 alee@fresnocountyca.gov Authorized HCPCFC Sign Print Title Date Email Program Representative: Budget Summary tables can be found on the"Summary Tables"sheet of this workbook. DHCS State of California—Health and Human Services Agency4NO, f•";`.'ty� Department of Health Care Services g.g-Ir Health Care Program for Children in Foster Care MICHELLE BAASS Budget Narrative GAVIN NEWSOM DIRECTOR GOVERNOR State/Federal Funding Source: Caseload Relief County/City Namej Fresno IFiscal Year 2023-24 I. Personnel Expenses Identify and Explain Any Changes in Personnel/Personnel Expenses Salary and Benefits for 2 positions,total of 1.5 FTE PHN. Includes retirement, health insurance, OASDI, Unemployment Insurance, and Benefits Administration. II. Operating Expenses Identify and Explain All Operating Expense Line Items Private auto mileage reimbursement at$0.655/mile for program staff travel to complete Travel: program activities and attend State-sponsored meetings, including regional meetings, subcommittee meetings, and training specific to job duties. Registration costs for PHNs to attend State recommended trainings and workshops to Training: maintain professional competence and gain program specific skills. Also includes ancillary costs related to attending training and State-convened meetings. III. Capital Expenses cannot be included in this budget IV. Indirect Expenses Indirect External Expenses cannot be included in this budget Identify and Explain All Indirect Expense Line Items Fresno County Department of Public Health's indirect rate is 18.314%of personnel costs Internal: approved for use by Fresno County's Auditor Controller/Treasurer-Tax Collector. V. Other Expenses cannot be included in this budget Chashua Loi 0 45135 Prepared By: Sign Print Title Date Email 4,kt� Z_"� Ankara Lee 0 45135 Authorized HCPCFC Program Representative: Sign Print Title Date Email d d WO w IV'•' •\`V� 2 C, G) •\,. •��..yv G CD LL a Y�t> ixii U T z U p o O o o O -'. N U L lfl V? CD .0 V1 cif CR _ o c E E U � v c a m m CD c. 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O a0 �Nj 1° Ic (O C•7 O W can cD um'i 1� = lL c•'i c'i N _ N d m p 00 a O Q1 m m Ln U C Q m V M I-- Ln m C i0ll m 00 0 L Q v .0 m Lo W xsi EL9 W vi t» tl') In UJ O v O CD C O m O fp o m in N p fp M W O N M C C n M N T is cp9 c, N ai LL Ef3 O w (V X E c i° No x .f9 0 U a w N O n N O N C N O < xa �a( n c a a 7 DTI m O C_ W W N CL Q U- F-ILy J W m Q J Ql 01 LL1 Yam' w LL a CU O_ L_ Of N 0) CD '6 ai LL N a_ 0 U C 0 0 O N 7 N N �r\7 L Ul Agreement Between the County of Fresno and California Department of Health Care Services Agreement Name: Health Care Program for Children in Foster Care FY 2023-24 Fund/Subclass: 0001/10000 Organization: 56201618 Revenue Account #: 4380, 3530