HomeMy WebLinkAboutAgreement A-25-388.pdf Agreement No. 25-388
MEDI-CAL COUNTY INMATE PROGRAM
CERTIFICATION OF VOLUNTARY CONTRIBUTIONS
TO NON-FEDERAL SHARE OF MEDICAID EXPENDITURES
State Fiscal Year 2024-25
On behalf of the County of Fresno (the Governmental Funding Entity), I hereby
certify that the intergovernmental transfer amount specified herein represents a voluntary
contribution by the Governmental Funding Entity to the non-federal share of Medicaid
expenditures for purposes of all federal laws, including, but not limited to Section
10201(c)(6)of the Patient Protection and Affordable Care Act(Public Law No. 111-148).
The funds transferred qualify for Federal Financial Participation (FFP) pursuant to 42
C.F.R. part 433, subpart B, and are not derived from impermissible sources. Govern-
mental Funding Entity shall indemnify DHCS for any deferral or disallowance of FFP
should funds transferred pursuant to this certification be deemed ineligible for FFP.
This voluntary contribution in the amount of$ 329,080 is intended to fulfill the
Governmental Funding Entity's responsibility for the non-federal share of certain
payments under the Medi-Cal County Inmate Program (MCIP) implemented in
accordance with California Welfare and Institutions Code (WIC) Section 14053.7 and
14053.8.
These funds are provided solely to enable DHCS to obtain FFP for MCIP payments as
permitted by federal law. In the event DHCS is unable to obtain FFP for these MCIP
payments, orthe full MCIP payments cannot otherwise be made to and retained by hos-
pital providers of acute inpatient services underthe MCIP, and therefore all or a portion
of the transferred amount cannot be used as intended, DHCS will notify the Govern-
mental Funding Entity and return the applicable portion of the unused intergovernmental
transfer amount. Amounts due to or owed by the Governmental Funding Entity may be
offset against future transfers related to MCIP as determined by DHCS. The govern-
mental funding entity may not receive and retain any of the Medicaid payments funded
by the IGT funds.
All records of public funds constituting the non-federal share are subject to review and
audit by DHCS. The Governmental Funding Entity understands that DHCS must deny
payment under WIC sections14053.7, 14053.8, and Penal Code 5072 if it is determined
that the IGT, the certification, or both is not adequately supported for purposes of claim-
ing FFP.
I am authorized to sign this certification of voluntary contributions on behalf of the Gov-
ernmental Funding Entity. I understand that knowingly filing a false or fraudulent state-
ment in support of a claim may violate the Federal False Claim Act or other applicable
statute, and be punishable thereunder.
Ernest Buddy Mendes.Chairman of the Board of Supervisors
Signature Title of Au hlorized Signatory
ATTEST:
BERNICDEL
County of Fresno Clerko theB E. and
_ v .�—�das Clerk of the Board of Supervisors
Governmental Funding Entity Date County of Fresno,State of California
By_ Deputy