HomeMy WebLinkAboutP-25-525 Procurement Agreement.pdf CO,U County of Fresno
GENERAL SERVICES DEPARTMENT
Facilities• Fleet• Purchasing• Security
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PROCUREMENT AGREEMENT
Agreement Number P-25-525
October 21, 2025
Fresno Interdenominational Refugee Ministries (FIRM)
1940 N Fresno St.
Fresno, CA 93703
The County of Fresno (County) hereby contracts with Fresno Interdenominational Refugee Ministries (FIRM)
to expand the doula workforce in Fresno County through a Doula Workforce Expansion Program in
accordance with the text of this agreement, Attachment"A-C" by this reference made a part hereof.
TERM: This Agreement shall become effective November 1, 2025 and shall remain in effect through
November 30, 2026.
EXTENSION: This Agreement may be extended for two (2)additional one (1)year periods by the mutual
written consent of all parties.
MINIMUM ORDERS: Unless stated otherwise there shall be no minimum order quantity. The County
reserves the right to increase or decrease orders or quantities.
CONTRACTOR'S SERVICES: Contractor shall perform the services as described in Attachment"A",
Attachment"B", and Attachment"C" attached, at the rates set forth in Attachment"A".
ORDERS: Orders will be placed on an as-needed basis by the Department of Public Health under this
contract.
PRICES: Prices shall be firm for the contract period.
MAXIMUM: In no event shall services performed and/or fees paid under this Agreement be in excess of
one-hundred thirty-one thousand, three-hundred twenty-six and seventy-six cents ($131,326.76).
ADDITIONAL ITEMS: The County reserves the right to negotiate additional items to this Agreement as
deemed necessary. Such additions shall be made in writing and signed by both parties.
DELIVERY: The F.O.B. Point shall be the destination within the County of Fresno. All orders shall be
delivered complete as specified. All orders placed before Agreement expiration shall be honored under the
terms and conditions of this Agreement.
DEFAULT: In case of default by Contractor, the County may procure the articles/services from another
source and may recover the loss occasioned thereby from any unpaid balance due the Contractor or by any
other legal means available to the County. The prices paid by County shall be considered the prevailing
market price at the time such purchase is made. Inspection of deliveries or offers for delivery, which do not
meet specifications, will be at the expense of Contractor.
Purchasing Services/333 W Pontiac Way/Clovis, California 93612/(559) 600-7110
*The County of Fresno is an Equal Employment Opportunity Employer*
PROCUREMENT AGREEMENT NUMBER: P-25-525 Page 2
Fresno Interdenominational Refugee Ministries (FIRM)
October 21, 2025
INVOICING: An itemized invoice shall be sent to requesting County department in accordance with invoicing
instructions included in each order referencing this Agreement. The Agreement number must appear on all
shipping documents and invoices. Invoice terms shall be Net 45 Days.
INVOICE TERMS: Net forty-five (45) days from the receipt of invoice.
TERMINATION: The County reserves the right to terminate this Agreement upon thirty (30) days written
notice to the Contractor. In the event of such termination, the Contractor shall be paid for satisfactory
services or supplies provided to the date of termination.
LAWS AND REGULATIONS: The Contractor shall comply with all laws, rules and regulations whether they
be Federal, State or municipal, which may be applicable to Contractor's business, equipment and personnel
engaged in service covered by this Agreement.
AUDITS AND RETENTION: Terms and conditions set forth in the agreement associated with the purchased
goods are incorporated herein by reference. In addition, the Contractor shall maintain in good and legible
condition all books, documents, papers, data files and other records related to its performance under this
contract. Such records shall be complete and available to Fresno County, the State of California, the federal
government or their duly authorized representatives for the purpose of audit, examination, or copying during
the term of the contract and for a period of at least three years following the County's final payment under the
contract or until conclusion of any pending matter(e.g., litigation or audit), whichever is later. Such records
must be retained in the manner described above until all pending matters are closed.
LIABILITY: The Contractor agrees to:
Pay all claims for damage to property in any manner arising from Contractor's operations under this
Agreement.
Indemnify, save and hold harmless, and at County's request defend the County, its officers, agents and
employees from any and all claims for damage or other liability, including costs, expenses (including
attorney's fees and costs), causes of action, claims or judgments resulting out of or in any way connected
with Contractor's performance or failure to perform by Contractor, its agents, officers or employees under this
Agreement, and from any and all costs and expenses (including attorney's fees and costs), damages,
liabilities, claims, and losses occurring or resulting to any person, firm or corporation who may be injured or
damaged by the performance, or failure to perform, of Contractor, its officers, agents, or employees under
this Agreement.
INSURANCE: Without limiting the COUNTY's right to obtain indemnification from CONTRACTOR or any
third parties, CONTRACTOR, at its sole expense, shall maintain in full force and effect, the following
insurance policies or a program of self-insurance, including but not limited to, an insurance pooling
arrangement or Joint Powers Agreement (JPA)throughout the term of the Agreement:
A. Commercial General Liability: Commercial general liability insurance with limits of not less than Two
Million Dollars ($2,000,000) per occurrence and an annual aggregate of Four Million Dollars
($4,000,000). This policy must be issued on a per occurrence basis. Coverage must include products,
completed operations, property damage, bodily injury, personal injury, and advertising injury. The
Contractor shall obtain an endorsement to this policy naming the County of Fresno, its officers, agents,
employees, and volunteers, individually and collectively, as additional insureds, but only insofar as the
operations under this Agreement are concerned. Such coverage for additional insureds will apply as
primary insurance and any other insurance, or self-insurance, maintained by the County is excess only
and not contributing with insurance provided under the Contractor's policy.
B. Automobile Liability: Automobile liability insurance with limits of not less than One Million Dollars
($1,000,000) per occurrence for bodily injury and for property damages. Coverage must include any auto
used in connection with this Agreement.
C. Professional Liability: Professional liability insurance with limits of not less than One Million Dollars
($1,000,000) per occurrence and an annual aggregate of Three Million Dollars ($3,000,000). If this is a
claims-made policy, then (1)the retroactive date must be prior to the date on which services began
P-25-525 Procurement Agreement
PROCUREMENT AGREEMENT NUMBER: P-25-525 Page 3
Fresno Interdenominational Refugee Ministries (FIRM)
October 21, 2025
under this Agreement; (2)the Contractor shall maintain the policy and provide to the County annual
evidence of insurance for not less than five years after completion of services under this Agreement; and
(3) if the policy is canceled or not renewed, and not replaced with another claims-made policy with a
retroactive date prior to the date on which services begin under this Agreement, then the Contractor shall
purchase extended reporting coverage on its claims-made policy for a minimum of five years after
completion of services under this Agreement.
D. Worker's Compensation: Workers compensation insurance as required by the laws of the State of
California with statutory limits.
Additional Requirements Relating to Insurance:
Contractor shall obtain endorsements to the Commercial General Liability insurance naming the County of
Fresno, its officers, agents, and employees, individually and collectively, as additional insured, but only
insofar as the operations under this Agreement are concerned. Such coverage for additional insured shall
apply as primary insurance and any other insurance, or self-insurance, maintained by County, its officers,
agents and employees shall be excess only and not contributing with insurance provided under Contractor's
policies herein. This insurance shall not be cancelled or changed without a minimum of thirty (30)days
advance written notice given to County.
Contractor hereby waives its right to recover from County, its officers, agents, and employees any amounts
paid by the policy of worker's compensation insurance required by this Agreement. Contractor is solely
responsible to obtain any endorsement to such policy that may be necessary to accomplish such waiver of
subrogation, but Contractor's waiver of subrogation under this paragraph is effective whether or not
Contractor obtains such an endorsement.
Within Thirty (30) days from the date Contractor signs and executes this Agreement, Contractor shall provide
certificates of insurance and endorsement as stated above for all of the foregoing policies, as required
herein, to the County of Fresno, Department of Public Health, ATTN: Contracts Section-6`floor PO
Box 11867, Fresno, CA 93775 or DPHContracts@fresnocountyca.gov, stating that such insurance
coverage have been obtained and are in full force; that the County of Fresno, its officers, agents and
employees will not be responsible for any premiums on the policies; that such Commercial General Liability
insurance names the County of Fresno, its officers, agents and employees, individually and collectively, as
additional insured, but only insofar as the operations under this Agreement are concerned; that such
coverage for additional insured shall apply as primary insurance and any other insurance, or self-insurance,
maintained by County, its officers, agents and employees, shall be excess only and not contributing with
insurance provided under Contractor's policies herein; and that this insurance shall not be cancelled or
changed without a minimum of thirty (30) days advance, written notice given to County. Certificates of
Insurance are to include the contract number at the top of the first page.
In the event Contractor fails to keep in effect at all times insurance coverage as herein provided, the County
may, in addition to other remedies it may have, suspend or terminate this Agreement upon the occurrence of
such event.
All policies shall be with admitted insurers licensed to do business in the State of California. Insurance
purchased shall be purchased from companies possessing a current A.M. Best, Inc. rating of A FSC VII or
better.
COMING ON COUNTY PROPERTY TO DO WORK: Contractor agrees to provide maintain and furnish
proof of Comprehensive General Liability Insurance with limits of not less than $500,000 per occurrence.
INDEPENDENT CONTRACTOR: In performance of the work, duties and obligations assumed by Contractor
under this Agreement, it is mutually understood and agreed that Contractor, including any and all of
Contractor's officers, agents, and employees will at all times be acting and performing as an independent
contractor, and shall act in an independent capacity and not as an officer, agent, servant, employee,joint
venturer, partner, or associate of the County. Furthermore, County shall have no right to control or supervise
or direct the manner or method by which Contractor shall perform its work and function. However, County
shall retain the right to administer this Agreement so as to verify that Contractor is performing its obligations
P-25-525 Procurement Agreement
PROCUREMENT AGREEMENT NUMBER: P-25-525 Page 4
Fresno Interdenominational Refugee Ministries (FIRM)
October 21, 2025
in accordance with the terms and conditions thereof. Contractor and County shall comply with all applicable
provisions of law and the rules and regulations, if any, of governmental authorities having jurisdiction over
matters the subject thereof.
Because of its status as an independent contractor, Contractor shall have absolutely no right to employment
rights and benefits available to County employees. Contractor shall be solely liable and responsible for
providing to, or on behalf of, its employees all legally-required employee benefits. In addition, Contractor
shall be solely responsible and save County harmless from all matters relating to payment of Contractor's
employees, including compliance with Social Security, withholding, and all other regulations governing such
matters. It is acknowledged that during the term of this Agreement, Contractor may be providing services to
others unrelated to the County or to this Agreement.
NON-ASSIGNMENT: Neither party shall assign, transfer or sub-contract this Agreement nor their rights or
duties under this Agreement without the written consent of the other party.
AMENDMENTS: This Agreement constitutes the entire Agreement between the Contractor and the County
with respect to the subject matter hereof and supersedes all previous negotiations, proposals, commitments,
writings, advertisements, publications, Request for Proposals, Bids and understandings of any nature
whatsoever unless expressly included in this Agreement. This Agreement supersedes any and all terms set
forth in Contractor's invoice. This Agreement may be amended only by written addendum signed by both
parties.
INCONSISTENCIES: In the event of any inconsistency in interpreting the documents which constitute this
Agreement, the inconsistency shall be resolved by giving precedence in the following order of priority: (1)the
text of this Agreement (excluding Attachment"A-C"); (2)Attachment"A-C".
GOVERNING LAWS: This Agreement shall be construed, interpreted and enforced under the laws of the
State of California. Venue for any action shall only be in County of Fresno.
ELECTRONIC SIGNATURES: The parties agree that this Agreement may be executed by electronic
signature as provided in this section.
A. An "electronic signature" means any symbol or process intended by an individual signing this Agreement
to represent their signature, including but not limited to (1) a digital signature; (2) a faxed version of an
original handwritten signature; or(3) an electronically scanned and transmitted (for example by PDF
document) of a handwritten signature.
B. Each electronic signature affixed or attached to this Agreement (1) is deemed equivalent to a valid
original handwritten signature of the person signing this Agreement for all purposes, including but not
limited to evidentiary proof in any administrative or judicial proceeding, and (2) has the same force and
effect as the valid original handwritten signature of that person.
C. The provisions of this section satisfy the requirements of Civil Code section 1633.5, subdivision (b), in
the Uniform Electronic Transaction Act (Civil Code, Division 3, Part 2, Title 2.5, beginning with section
1633.1).
D. Each party using a digital signature represents that it has undertaken and satisfied the requirements of
Government Code section 16.5, subdivision (a), paragraphs (1)through (5), and agrees that each other
party may rely upon that representation.
This Agreement is not conditioned upon the parties conducting the transactions under it by electronic means
and either party may sign this Agreement with an original handwritten signature.
Please acknowledge your acceptance by returning all pages of this Agreement to my office via email or
USPS.
Please refer any inquiries in this matter to Amber Siner, Purchasing Analyst at 559-600-7117 or
asiner@fresnocountyca.gov.
P-25-525 Procurement Agreement
PROCUREMENT AGREEMENT NUMBER: P-25-525 Page 5
Fresno Interdenominational Refugee Ministries (FIRM)
October 21, 2025
FOR THE COUNTY OF FRESNO
Digitally signed Rleyckburn
Riley Blackburn Date:2025.11.14y11:16:3B3a08'00'
Riley Blackburn
Purchasing Manager
333 W. Pontiac Way
Clovis, CA 93612
P-25-525 Procurement Agreement
PROCUREMENT AGREEMENT NUMBER: P-25-525 Page 6
Fresno Interdenominational Refugee Ministries (FIRM)
October 21, 2025
CONTRACTOR TO COMPLETE:
Company: Fresno Interdenominational Refugee Ministries (dba FIRM)
Type of Entity:
❑ Individual ❑ Limited Liability Company
❑ Sole Proprietorship ❑ Limited Liability Partnership
Corporation ❑ General Partnership
1940 N. Fresno Fresno CA 93703
Address City State Zip
559.487.1500 559.487.1550 yaomee@firminc.org
TELEPHONE NUMBER FAX NUMBER E-MAIL ADDRESS
Print Name & Matias Bernal, Board Treasurer
Title: Print Name &'Jils"
Signature: Tho-Lee(Nov iz,zozsis:nz:z9PST) Signature:
ACCOUNTING USE ONLY
ORG No.: 56201715
Account No.: 7295
Requisition No.: 5622600249
(7/2024)
P-25-525 Procurement Agreement
PROCUREMENT AGREEMENT NUMBER: P-25-525 Attachment Page 1 of 3
Fresno Interdenominational Refugee Ministries (FIRM)
October 21, 2025
ATTACHMENT'A"
Budget-Contract Term:November 1,2025-November 30,2026
Vendor Name:Fresno Interdenominational Refugee Ministries
BUDGET SUMMARY
BUDGET CATEGORIES Total Cost
PERSONNEL EXPENSES
Salaries $16,129.86
Payroll Taxes $1,209.74
Benefits $1,693.64
Subtotal Personnel $19,033.23
SERVICES&SUPPLIES EXPENSES
Doula Training Program Facilitators $38,016.00
Doula Mentors $12,000.00
Doula Training Guest Speakers $4,000.00
Doula Trainee Stipends $20,000.00
Doula Graduation Ceremony $9,794.00
Professional Certification Payments $8,000.00
Professional Liability Coverage for
$7,000.00
Doulas
Rent $2,850.00
Office supplies $1,800.00
utilites $6,000.00
printing $253.52
nonpersonnel liability insurance $2,580.00
Subtotal Services&Supplies $112,293.52
Indirect Expenses $0.00
TOTAL EXPENSES $131,326.76
P-25-525 Procurement Agreement
PROCUREMENT AGREEMENT NUMBER: P-25-525 Attachment Page 2 of 3
Fresno Interdenominational Refugee Ministries (FIRM)
October 21, 2025
PERSONNEL DETAIL
Position %FTE on Salary or Total Cost Description/Justification
Project Hourly Wage
Expense is to cover Finance Director's time to oversee
Finance&Operations Director 5% $88,000.00 $4,230.77 financial records and reconciliations of expenses relating
to program.$88,000*0.05 FTE=$4,230.77 for 12 months
Expense is to cover Bookkeeper's time in processing
Bookkeeper 6% $24.50 $2,940.00 payroll,check requests,and financial record keeping
relating to program.$24.50*120 hrs=$2,940.
Expense is to cover ED's time overseeing project and
Executive Director 7% $95,000.00 $6,909.09 ensuring deliverables are met.$95,000*0.07 FTE_
$6,909.09 for 12 months
Expense is to cover Office Manager's time in assisting
Office Manager 5% with printing and prepping for monthly activities relating to
g $20.50 $2,050.00 project.$20.50*100 hrs during a 12 month period=
$2,050
Total Salaries $16,129.86
Payroll Taxes $1,209.74 Tax calculation at 7.5%
Benefit Item Total Cost Description/Justification
Health Benefits $887.14 Health benefit calculation at 5.5%
Retirement Plan $483.90 Retirement benefit calculation at 3%
Work Comp $322.60 Work Comp calculation at 2%
$0.00
Total Benefits $1,693.64
July 2025 2 California Department of
Public Health
PROCUREMENT AGREEMENT NUMBER: P-25-525 Attachment Page 3 of 3
Fresno Interdenominational Refugee Ministries (FIRM)
October 21, 2025
SERVICES&SUPPLIES DETAIL
BUDGET CATEGORIES Subtotal Total Cost Description/Justification/Calculations
Trained Facilitators responsible for coordinating and implementing the HCO
Doula Training Program Facilitators $38,016.00 curriculum
Experienced Doula providing one-on-one mentorship and real world training
Doula Mentors $12,000.00 guidance.Monthly gift card compensation to ensure retention of quality
mentors and acknowledge their significant time commitment in supporting
doula trainee development.
Specialized experts providing focused training on critical topics.$100
Doula Training Guest Speakers $4,000.00 honorarium per session ensures access to qualified professionals who bring
valuable expertise and real-world perspective to enhance the training
curriculum
Doula Trainee Stipends $209000.00 Stipend payments incentivize program completion while reducing financial
barriers to participation.
Doula Graduation Ceremony $9,794.00 Celebrates participant achievement and professional development
Professional Certification Payments $8,000.00 doula practice including HIPAA certification,CPR certification,and
back d c rounhecks
Professional Liability Coverage for our ina a in l ua coverage protessional nonmedical is i i y for doulas
Doulas $7,000.00 in order to participate in training,observations and build their capacity for
first year of their services
Rent $2,850.00 Monthly rent=$2,375*10%allocated to cover space usage for staff
on the project=$237.50*12 months=$2,850.
Office supplies $13800.00 Supplies purchase will include admin shared office supplies such
as printing papers,file folders,pens,and sticky notes
Monthly shared utility cost for project at 10%of FIRM's overall monthly
utilites $6,000.00 utility expense estimation of$5,000 per month
printing $253.52 Shared cost of monthly printing expense.
Organizational liability insurance $2,580.00 employees for non-medical professional services
x 12 months=$1,800
Total Services&Supplies $112,293.52
July 2025 3 California Department of
Public Health
PROCUREMENT AGREEMENT NUMBER: P-25-525 Attachment Page 1 of 4
Fresno Interdenominational Refugee Ministries (FIRM)
October 21, 2025
Attachment "B"
Scope of Work
Fresno Interdenominational Refugee Ministries (FIRM)
Fresno County Doula Workforce Expansion Program
Service Specific Activities Deliverables Outcomes
Area/Core
Function
Doula Training • Support implementation of • Curriculum implementation • Maintain 80%participant
Curriculum Health Connect One(HCO) plan attendance rate for training
Implementation doula training curriculum, • Training schedule with sessions
consisting of 20 interactive dates,times,and locations • Complete 100% of
sess 1 Ons •Attendance logs for all 20 scheduled training modules
•Utilize staff who are sessions on time
certified HCO facilitators to •Participant progress tracking • Achieve 90%participant
assist with: system retention rate throughout
•Pre/post training the program
• Planning and assessments •Document 100% of
facilitating • Training materials(digital participant progress and
curriculum sessions and print) completion status
• Coordinating training •Monthly training progress • Increase in participant
logistics including reports knowledge and skills as
venue setup, measured by pre/post
scheduling, and assessments
technology needs
• Preparing training
materials for all
participants
• Adapting curriculum
content to reflect
cultural needs of
Fresno County's
diverse communities
while maintaining
fidelity to core
components
• Conducting pre and
post assessments of
participant
knowledge and skills
PROCUREMENT AGREEMENT NUMBER: P-25-525 Attachment Page 2 of 4
Fresno Interdenominational Refugee Ministries (FIRM)
October 21, 2025
Financial Process and distribute all • Monthly payment • Process 100% of
Management and program payments according processing logs payments within 30 days of
Fund Distribution to FCDPH PEI established • Recipient payment authorization
schedules: documentation with • Maintain 100%accuracy
signatures in payment distributions
• Program facilitators: • Gift card distribution • Ensure all program
Monthly payments at records participants receive
$22/hour(maximum •Budget tracking spreadsheet payments according to
12 hours per week for • Financial reconciliation schedule
each facilitator) reports
PROCUREMENT AGREEMENT NUMBER: P-25-525 Attachment Page 3 of 4
Fresno Interdenominational Refugee Ministries (FIRM)
October 21, 2025
• Doula Mentors: • Fund distribution schedule • Document 100% of
Distribute$100 Visa • Payment method financial transactions with
gift cards monthly to documentation required supporting
each mentor • Monthly financial reports to materials
• Doula Trainee PEI Coordinator • Support program
stipends:Three-part retention through timely
payments of$500 per financial incentives
participant: Initial
payment($167),
Mid-Program
payment($167),
Final payment$ 166
• Guest Speakers: $100
Visa gift card per
session
• Professional
Certifications:
Process payments for
HIPAA, CPR, and
Background checks
• Doula Graduation
Ceremony:Process
all expense payments
as directed by
FCDPHPEI
Maintain fiscal oversight and
accountability:
• Track all
expenditures against
the approved budget
• Maintain detailed
financial records and
payment
documentation
• Reconcile all
financial transactions
monthly
• Implement financial
controls to ensure
accuracy and prevent
fraud
• Provide regular
financial status
updates to FCDPH
PROCUREMENT AGREEMENT NUMBER: P-25-525 Attachment Page 4 of 4
Fresno Interdenominational Refugee Ministries (FIRM)
October 21, 2025
Administrative • Prepare and maintain • Tax documentation files • Submit 100%of monthly
and Fiscal accurate tax documentation • Monthly invoices with invoices by the 15th of
Compliance (W-9, 1099 forms) for all supporting documentation each month
payments processed • Secure filing system • Complete 100% of
• Submit detailed monthly required tax documentation
invoices to FCDPH by the on time
15th of each month • Pass any financial audits
• Establish and maintain with minimal findings
organized filing system for •Maintain compliance with
all financial documents all county and state fiscal
• Secure and protect requirements
confidential financial and •Respond to financial
personal information information requests within
• Respond to audit requests 2 business days
and information needs
Program • Participate in biweekly • Meeting attendance logs • Maintain 95%attendance
Coordination and meetings with FCDPH PEI • Communication logs rate at required FCDPH
Communication staff • Payment schedule meetings
• Serve as fiscal liaison coordination documentation •Ensure clear
between program • Issue resolution communication regarding
participants and FCDPH documentation all financial matters
• Coordinate payment •Resolve payment issues
schedules with program within 3 business days
implementation timeline •Maintain positive
• Communicate payment relationships with all
status and updates to FCDPH program stakeholders
PEI staff • Support program success
• Collaborate with FCDPH through effective fiscal
PEI staff to resolve payment coordination
issues • Minimize payment delays
• Document decisions and disruptions
regarding fund disbursement
• Maintain regular
communication with all
payment recipients
Financial • Design and implement • Comprehensive financial • Provide 100%accurate
Tracking and comprehensive financial tracking system financial data for program
Reporting tracking systems • Monthly financial status management
• Generate monthly financial reports • Support program
reports detailing all • End of Fiscal Year financial evaluation through
transactions summary report comprehensive financial
• Maintain electronic data
database of all financial • Identify and address
transactions budget concerns
•Prepare final program proactively
financial summary report •Ensure transparent
financial management
Attachment "C"
�CDPH
California Ue1h.11—t of
Public Health
Maternal, Child and Adolescent Health Division
Fiscal Administration Policy & Procedure Manual
oil I
, %= to
This manual applies to Local Health Jurisdictions (LHJs) and Community
Based Organizations (CBOs) operating the:
• Maternal, Child and Adolescent Health (MCAH) Program
• Black Infant Health (BIH) Program
• Adolescent Family Life Program (AFLP)
• California Home Visiting Program (CHVP)
• Perinatal Equity Initiative (PEI)
PROCUREMENT AGREEMENT NUMBER: P-25-525
Fresno Interdenominational Refugee Ministries (FIRM)
October 21, 2025
TABLE OF CONTENTS
AdministrativeFunding ............................................................................................. 7
Overview ......................................................................................................................... 7
HRSA Grants — Title V Block Grant and MIECHV............................................................ 7
StateGeneral Funds ....................................................................................................... 8
AgencyFunds ................................................................................................................. 8
CertifiedPublic Funds...................................................................................................... 9
Title XIX Medi-Cal Funds ................................................................................................. 9
Community Based Organizations (CBOs)................................................................... 9
GrantRequirements ...................................................................................................... 10
UEI and SAM.GOV Registration Requirements........................................................ 10
AgencyResponsibilities............................................................................................ 10
Noncompliance Consequences ................................................................................ 10
Federal Financial Participation............................................................................... 11
Overview..........................................................................................................................11
Documentation for FFP Claiming................................................................................... 11
Policy.......................................................................................................................... 11
Documentation ......................................................................................................... 12
FFP Ineligible Activities............................................................................................. 12
ClaimingFFP Funds................................................................................................. 13
FFPTime Studies.......................................................................................................... 13
Requirements ........................................................................................................... 13
Time Study Data Summary Report Format............................................................... 14
FFP Time Studies & Function Codes........................................................................ 16
Reimbursement Rates & Function Codes................................................................. 18
Additional Time Worked............................................................................................ 20
July 2025 3 . California Department of
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PROCUREMENT AGREEMENT NUMBER: P-25-525
Fresno Interdenominational Refugee Ministries (FIRM)
October 21, 2025
FFPFunction Codes................................................................................................. 20
FFP (Title XIX) Decision Tree ....................................................................................21
SPMP Requirements: Professional Classification .......................................................... 22
Policy........................................................................................................................ 22
SPMP Requirements Professional Education and Training ........................................... 23
Policy........................................................................................................................ 23
Procedure................................................................................................................. 23
Example of SPMP Questionnaire.............................................................................. 24
SPMP Requirements: Activity........................................................................................ 25
Policy........................................................................................................................ 25
Title XIX Claiming Cover Letter................................................................................. 25
AttestationForm ....................................................................................................... 30
Medi-Cal Percentage (MCP).................................................................................... 31
Policy............................................................................................................................. 31
Base Medi-Cal Percentage............................................................................................ 31
AFLP Base Medi-Cal Percentage ............................................................................. 31
BIH Program Base Medi-Cal Percentage.................................................................. 31
MCAH Program Base Medi-Cal Percentage............................................................. 31
Local Medi-Cal Percentage MCP................................................................................... 32
Multiple Medi-Cal Percentage MCP For Single Staff...................................................... 32
Weighted Medi-Cal Percentage..................................................................................... 33
Variable Medi-Cal Percentage....................................................................................... 34
MCAH Director- Medi-Cal Percentage (MCP)............................................................... 35
Policy........................................................................................................................ 35
Procedure................................................................................................................. 35
Requirements ........................................................................................................... 36
July 2025 4 . California Department of
kI Public Health
PROCUREMENT AGREEMENT NUMBER: P-25-525
Fresno Interdenominational Refugee Ministries (FIRM)
October 21, 2025
MCP Annual AFA Justification letter.............................................................................. 37
Policy........................................................................................................................ 37
Title V 30/30 Earmarking.......................................................................................... 38
Overview ....................................................................................................................... 38
Requirements ........................................................................................................... 38
TitleV Time Studies ...................................................................................................... 38
BudgetsDocuments................................................................................................. 39
Overview ....................................................................................................................... 39
Budget/Invoice Template............................................................................................... 39
BudgetSummary........................................................................................................... 40
Procedure................................................................................................................. 40
(1) Personnel............................................................................................................. 41
(II) Operating Expenses............................................................................................ 43
(III) Capital Expenditures .......................................................................................... 47
(IV) Other Costs........................................................................................................ 47
(V) Indirect Cost........................................................................................................ 48
BudgetRevisions ..................................................................................................... 50
Overview ....................................................................................................................... 50
Requirementsfor BR's................................................................................................... 50
Invoices and Payments ............................................................................................ 51
Invoices ......................................................................................................................... 51
Invoice Submission (How to Submit Your Invoice).................................................... 51
Special Considerations............................................................................................. 53
Supplemental Invoices.............................................................................................. 54
Invoice Detail Worksheet.......................................................................................... 54
InvoiceDeadlines ..................................................................................................... 55
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Payments ...................................................................................................................... 55
MaximumAmounts Payable ..................................................................................... 55
Reimbursement Limitations ...................................................................................... 55
Recovery of Overpayments ...................................................................................... 56
Procedures ............................................................................................................... 56
PaymentWithholds................................................................................................... 57
Audits ........................................................................................................................... 58
Overview ....................................................................................................................... 58
On-Site Technical Assistance Reviews.......................................................................... 58
CorrectiveAction Plan ................................................................................................... 58
AuditRequirements....................................................................................................... 59
Remedies for Audit Noncompliance............................................................................... 59
Terms and Conditions ............................................................................................. 60
General Terms and Conditions...................................................................................... 60
Special Terms and Conditions....................................................................................... 60
Additional MCAH Provisions .......................................................................................... 60
Subcontract Requirements ....................................................................................... 60
Audit and Record Retention...................................................................................... 61
Capital Expenditures and Inventory Controlled Items................................................ 62
EquipmentDisposition.............................................................................................. 62
Glossary of Terms and Acronyms ........................................................................ 63
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October 21, 2025
Administrative Funding
Overview
Under the California Department of Public Health (CDPH), the State Maternal, Child
and Adolescent Health (MCAH) administers federal and state funds to local partners
to promote the health of women of reproductive age, pregnant women, mothers,
infants, children, and adolescents in California.
State MCAH will administer funds to Local Health Jurisdictions (LHJs) and
Community Based Organizations (CBOs) annually through contracts and/or
allocation agreements. All contracts and allocation agreements are subject to federal
and state funding appropriations.
Funding sources that support MCAH activities include the Title V Block Grant, the
Maternal, Infant and Early Childhood Home Visiting Grant (MIECHV), State General
Funds (SGF), and Title XIX (Medicaid) Funds.
HRSA Grants - Title V Block Grant and MIECHV
The Title V Block Grant is federally administered by the Health Resources and
Services Administration (HRSA). Title V Block Grant funds are used to reimburse
MCAH, Black Infant Health (BIH), and Adolescent Family Life Program (AFLP)
program expenses incurred for activities consistent with the goals and purposes of
the grant.
The Title V Block Grant is authorized under the Social Security Act of 1935.
CDPH/MCAH applies annually for Title V funds to maintain Title V programs.
CDPH/MCAH may use Title V Block Grant funds for the provision of health services
and related activities (including planning, administration, education, and evaluation)
in accordance with the CDPH/MCAH application. The Title V Block Grant funds may
not be used for cash payments to intended recipients of health services or for
purchase of land, buildings, or major medical equipment.
Title V funds help each state to:
• Assure access to quality maternal and child health care services for
mothers and children, especially for those with low-incomes or limited
availability of care.
• Reduce infant mortality.
• Provide access to prenatal, delivery, and postnatal care, especially for
pregnant women who are low-income.
• Increase regular screenings and follow-up diagnostic and treatment
services for children who are low-income.
• Provide access to preventive and primary care services for children
who are low-income and rehabilitative services for children with
special health needs.
• Implement family-centered, community-based, systems of coordinated
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*Public Health
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October 21, 2025
care for children with special health care needs.
• Set up toll-free hotlines and assistance with applying for services to
pregnant women with infants and children eligible for Medicaid.
Pursuant to the Federal Social Security Act (42 U.S.C., Section 704), the Agency cannot
use Title V or MIECHV funds to:
• Provide inpatient services.
• Make cash payments to intended recipients of health services.
• The purchase or improvement of land; construction; or permanent
improvement (other minor remodel) of any building or facility, or the
purchase of major medical equipment.
• Satisfy any requirement for the expenditure of non-federal funds as a
condition for the receipt of federal funds.
• Provide funds to any entity other than a public or non-profit private
entity for research or training services.
• Payment for any item or service (other than an emergency item or service)
furnished by:
• An individual or entity during the period such individual or entity
is excluded from participation in any other federally funded
program, and/or
• At the medical direction or on the prescription of a physician during the
period when the physician is excluded from participation in any other
federally funded program.
State General Funds
State General Funds (SGFs) are used to enhance and promote MCAH programs.
Pursuant to Section 123255 of the California Health and Safety Code, SGFs are
used to maximize the reimbursement of available federal funds claimable under
Title XIX of the Federal Social Security Act (42 U.S.C., Sec. 1396 et seq.).
Agency Funds
Agencies contribute funds toward the total cost of operating and promoting MCAH
programs. Pursuant to Section 123255 of the California Health and Safety Code,
non- federal agency funds can maximize the use of available matching federal
funds claimable under Title XIX of the Federal Social Security Act (42 U.S.C., Sec.
1396 et seq.).
Agencies that receive Title V Block Grant funding and contribute Agency funds must
report the Agency funds in the proposed program budget and the monthly/quarterly
invoices.
July 2025 g California Department of
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PROCUREMENT AGREEMENT NUMBER: P-25-525
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Certified Public Funds
Title 42 of the Code of Federal Regulations (42 CFR), Section 433.51, which is
based on the authority of Section 1903(a) of the Social Security Act, provides:
(a) Public funds may be considered as the State's share in claiming Federal
Financial Participation (FFP) if they meet the conditions specified in
paragraphs (b) and (c) of this section.
(b) The public funds are appropriated directly to the State or local Medicaid
agency or transferred from other public agencies (including Indian tribes)
to the State or local agency and under its administrative control or
certified by the contributing public agency as representing expenditures
eligible for FFP under this section.
(c) The public funds are not federal funds, or are federal funds
authorized by federal law to be used to match other federal funds.
CBOs contracting with the CDPH/MCAH or subcontracting with an LHJ under
MCAH Programs may utilize public funds that must be certified by a public agency
as funds eligible for the drawdown of Federal Financial Participation.
Questions regarding use of funds not identified should be directed to your assigned
Contract Liaison.
Title XIX Medi-Cal Funds
Federal Title XIX Medi-Cal (Medicaid) funds may be used to reimburse a
percentage of expenses incurred for personnel and associated operating costs for
matchable activities. Title XIX matching funds are applicable only to programs that
serve Medi-Cal members. The budget may include Title XIX federal funds matched
at either an Enhanced rate (75% federal funds and with 25% agency general
funds/SGF) or Non-Enhanced rate (50% federal funds and with 50% agency
general funds/SGF). Agencies claiming Title XIX funding must conform to
requirements contained in the FFP section of this Policy and Procedure Manual.
Community Based Organizations (CBOs)
CBOs receiving MCH Block Grant funds to provide AFLP services are eligible for FFP.
The Non-Enhanced rate (50/50) can be claimed for any of the agency's staff involved in
activities that are necessary for proper and efficient Medi-Cal administration. As non-
government agencies, CBOs are prohibited by Federal regulations from claiming and
receiving the Enhanced rate matching of 75/25.
July 2025 9 California Department of
*Public Health
PROCUREMENT AGREEMENT NUMBER: P-25-525
Fresno Interdenominational Refugee Ministries (FIRM)
October 21, 2025
Grant Requirements
UEI and SAM.GOV Registration Requirements
All agencies receiving federal funds through the CDPH/MCAH must be registered with
the federal System for Award Management (SAM.gov) and possess an active Unique
Entity Identifier (UEI). This requirement applies to both direct recipients and
subrecipients of federal funds. The UEI has replaced the legacy DUNS number and
serves as the official identifier for federal awards.
Agencies are required to comply with federal regulations:
• 2 CFR Part 25 — Universal Identifier and System for Award Management
• 2 CFR Part 200 — Uniform Administrative Requirements, Cost Principles, and
Audit Requirements for Federal Awards
These requirements promote transparency, accountability, and regulatory compliance in
the use of federal funds.
Agency Responsibilities
Agencies receiving federal funding must:
1. Obtain a UEI through SAM.gov prior to applying for or receiving federal funding
(prior to initial Agreement Funding Application (AFA) process).
2. Maintain an active SAM.gov registration for the entire duration of the agreement.
3. Ensure that all subrecipients and subcontractors receiving federal funds are also
registered in SAM.gov and fully compliant.
4. Provide verification of UEI and active SAM.gov registration upon request or as
part of the award documentation.
Noncompliance Consequences
Failure to comply with UEI and SAM.gov registration requirements may result in:
• Delays in contract execution
• Suspension or withholding of federal funds
• Disallowance of associated costs
• Termination of the funding agreement
• CDPH/MCAH reserves the right to purse corrective actions or enforcement
measures in accordance with 2 CFR 200.339 in cases of noncompliance by a
subrecipient.
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Federal Financial Participation
Overview
Fiscal support for programs is available from federal Medicaid Title XIX funds. This
fiscal support is called Federal Financial Participation (FFP). The LHJs, i.e., city or
county health departments, and CBOs responsible for the public health needs in
the designated geographic area can claim partial reimbursement through FFP Title
XIX funds. Programs can claim FFP funds when activities meet at least one (1) of
the two (2) FFP objectives:
1 . Assisting individuals eligible for Medi-Cal to enroll in the Medi-Cal program.
2. Assisting members on Medi-Cal to access Medi-Cal services.
The Centers for Medicare and Medicaid Services (CMS) regulations allow matching
for administrative activities that are reimbursable at a Non-Enhanced rate (50/50)
for the majority of expenses necessary for the proper and efficient administration of
the Medi-Cal program. CMS also allows reimbursement at an Enhanced rate
(75/25) for certain activities performed by Skilled Professional Medical Personnel
(SPMP) that require specified education and/or training, as well as their direct
clerical support that require specified education and/or training, as well as their direct
clerical support.
This reimbursement:
1. is provided through matching Medi-Cal Title XIX funds with local
agency general funds and/or State MCAH allocated SGF to maximize
funding for the Program.
2. applies to personnel employed directly by an FFP
participating agency or subcontracted agency.
Documentation for FFP Claiming
Policy
The following types of documentation must be part of the agency's time study/FFP audit
file:
• Organization chart(s)
• Job specification for each SPMP position
• Position duty statement for each employee
• Training log, agenda/brochure of training, and registration receipt
• Correspondence related to CDPH/MCAH FFP policies
• Supporting documentation
• Working papers used to calculate/develop invoices
• SPMP questionnaire for claiming status
• Signed time studies
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October 21, 2025
3ocumentation
Supporting documentation to verify and substantiate appropriate Title XIX
claiming and percentages of FFP matching must be maintained at all times and,
when applicable, provided during on-site audits and/or by written request by
CDPH/MCAH. Examples of supporting documentation include daily logs,
appointment books, event flyers, meeting agendas with minutes, calendars,
journals, and day planners. This documentation must identify the following:
• Staff name(s), Position(s), and applicable Title XIX matchable program(s)
• Date of each activity or activities
• Amount of time spent on each activity or activities
• Narrative description of activities conducted and how they support the applicable
• Number of clients seen or contacted (target audience), which should be
broken out by Medi- Cal eligible clients versus non-Medi-Cal eligible clients
whenever possible. Documentation submitted to CDPH can be deidentified
and aggregated for reporting purposes, but original records should be
maintained in the case of an audit by CDPH or State control agency.
• When using a variable Medi-Cal Percentage (MCP), verification and
documentation of Medi-Cal enrollment is required (see the Medi-Cal
Percentage section of this manual for more information).
Time study documents, including supporting documentation, must be kept for a
minimum of seven years from the date of the last payment for the fiscal year, and
must be presented to MCAH upon request at any time.
FFP Ineligible Activities*
The following list summarizes the Medi-Cal activities and/or services that are not eligible
for federal reimbursement:
• Other Programs/Activities
• Direct Patient Care
• Outreach to Non Medi-Cal Programs
• Referral, Coordination, and Monitoring of Non Medi-Cal Services
• Facilitating Non Medi-Cal Application
• Arranging and/or Providing Non-Emergency, Non-Medical Transportation to a
Non Medi-Cal covered Service
• Contract Administration for Non Medi-Cal Services
• Program Planning and Policy Development for Non Medi-Cal Services
• Non-Targeted Case Management
*See full list in the DHCS County-Based Medi-Cal Administrative Activities (CMAA)
Operational Plan.
Additional examples of unallowable FFP expenses include but are not limited to:
• Malpractice insurance
• Equipment used for providing medical treatment
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• Medical Supplies
• Drugs and Medications
• Payments made to resolve audits
• Costs of elected officials and their related costs
• Costs for lobbying activities
• Fund Raising
Note: If you have questions regarding allowable activities, please consult your Program
Consultant.
Claiming FFP Funds
There are two factors that determine the amount of FFP funds an agency can claim:
1. Title XIX time studied activities
2. Agency's Medi-Cal Percentage (MCP)
FFP Time Studies
To claim Medi-Cal Title XIX funds, agency budgeted staff must document, through
time studies, actual staff time worked in all programs during the time study period.
Time studies are the primary documentation source of FFP and used to determine
the percent of personnel time that is matchable and non-matchable. The time
claimed to receive FFP match must be spent performing Medi-Cal administrative
activities that meet at least one of the two FFP objectives.
Requirements
Each person listed on a program budget claiming Title XIX activities (full-time, part-
time, or temporary staff) must complete weekly time studies that document 100% of
their paid work time for a minimum of one full month each quarter and submit a state
MCAH time study data summary form or alternate approved format.
Note: At times of a state of emergency, such as the COVID-19 pandemic, staff may
be required to time study everyday as a perpetual time study until CDPH/MCAH
provides guidance that the requirement is no longer necessary.
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PROCUREMENT AGREEMENT NUMBER: P-25-525
Fresno Interdenominational Refugee Ministries (FIRM)
October 21, 2025
ime-Study Uato Report for Summary of FFP (Q.1)
AGENCY- TIME STUDY PERIOD:
LAST NAME: TIME 5TUDY MONTH:
FIRST NAME-
JOB TITLE-
SPMP=
TIME BASE:
The percentages below are based on the program activities performed by this staff member
and can only be used to invoice for the Fiscal Year and Time Study Period entered above,
Directions-Please enter the budget line number,program name;and Medi-Cal Factor(MCFI%far each program the staff vrcrks in.
For subprograms or MCAH,BIH,ARLP,enter them after the main program name e_g_,KWM-SIDS
Percentage Distribution of Staff Time by Program
Program % of
Referen Budget Not Non- time in Medr-Cal
ce Line# Program Matchable Enhanced Enhanced Pro ram' Factor'1.
A --- ------------ -- -------------- ---- --------------------- -- ---------------- ---------------- .--------- ---- --------- _--- --------------.
B
C
D
E
IF
G
-.... ...... ........... .... .............................................. ................... ............--------.................... .......--........I-
I ................
Staff FFP Report MCAH Dlr
Note: Prior approval of an alternate time study format or data collection system
must be approved by MCAH prior to implementation. Agencies must retain
MCAH written approval for audit and administrative purposes while receiving
MCAH Funding and provide such information to MCAH upon request.
Annually during the AFA process, all MCAH agencies must designate in writing their
time study month as (1 st, 2nd, or 3rd month) and must remain constant with the time
study period throughout the fiscal year. Any deviation from the approved period
must be pre-approved by the MCAH Program Consultant and Contract Liaison via
formal written approval.
Time Study Data Summary Report Format
All MCAH funded agencies must use the MCAH developed time study template
unless they have received formal written approval to use an alternate template. If an
alternate time study data summary report format is approved, it must be consistent
with the MCAH Time Study Data Summary Report components identified below:
• Agency name
• Time study period
• Time study month
• First and last name of employee
• Employee classification or title
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Fresno Interdenominational Refugee Ministries (FIRM)
October 21, 2025
• Time base (e.g., full-time or part-time)
• Employee eligible for SPMP (e.g., "yes" or"no")
• Budget line number
• Percent of time studied to each program listed
• Percentage of time by activity classification
o Enhanced (75/25)
o Non-Enhanced (50/50)
o Unmatched - Not eligible for any Title XIX matching funds
• If applicable, MCP for each program and/or employee listed
The signed invoice package submission certifies and verifies all documents including
the time studies. If staff does not conduct a time study within the required time study
period, FFP is not claimable, and your invoice will be rejected. Please consult your
Contract Liaison and Program Consultant with any time study questions.
July 2025 15 California Department of
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PROCUREMENT AGREEMENT NUMBER: P-25-525
Fresno Interdenominational Refugee Ministries (FIRM)
October 21, 2025
FFP Time Studies & Function Codes:
The time study report is the mechanism used to document reimbursable activities
performed by staff. There are 12 total function codes used to identify these unique set of
activities, including paid time-off.
When completing the time study, enter a time to the appropriate function code (1-12) and
a program code (A-L) into each weekly slot. Time worked in programs other than MCAH
programs must be coded to Other Programs. See example below:
FFP Monthly Time Study Calculation
Allocated Functions
Manual Entry of
Funedon Code Week1 Week2 Weekl Weak1 Weeks Totals Toml
10
12 3 00 7.00
3.00 3.00
Program A: MCAH
Manual Entry of
Function Code Weak Weak Week Weak Week5 Totals Total
Al 3.00 3.00
A2 6.00 8.00
A3 3.00 3.00
A4 1-00 6 00 7.00
A5
A6 700 7.00
Al 0.50 2.00 2.50
AB
A91 2.00 1 1 1 1 11.00
A11111 0.50 1 8.00 1 3.00 1 111.50
22.00 14.00 8.00 44.00
Program B: MCAH-SIDS
Manual Entry of
Function Code WeekI Weak Weak Weak4 Met,5 Totals Total
Bl
B2
B3
114
135
B6
B7
BB
09
B11 1 00 3 00 6.00 1000
1.00 3.00 6.00 f0.00
Program C: BIH
Manual Entry of
.Function Code Week 1114e1t2 R11111111111 Week3 111feak4 MM1ek5 Totals Total
cl
C2
C3 4.00 4.00
C4
C5
C6 5.00 5.00
C7
CB
C9
C 19 40.00 2000. 10.00 70.00
4.00 40.00 20.00 15.00 79.00
Program D: Other Programs
Manual Entry of
Function Code Week 1 Week 2 Week 3 Week Week 5 Totals Total
D7
D2 5.00 5.0D
D3 3.00 3.00
D4 8 00 3.00 11.00
D5
D6
D7
DB 8.00 8.00
D9
D11
16.00 11.00 17.00
Note: Time spent doing the following administrative activities associated with a function
code is to be considered as time spent doing the function.
• The performance of necessary paperwork, travel, and
supervision including the supervision of the SPMP staff by a
SPMP supervisor.
• Employee break time is coded to the activity the employee is engaged in
immediately before or
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kk Public Health
PROCUREMENT AGREEMENT NUMBER: P-25-525
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October 21, 2025
• after the break period. Lunchtime is NOT coded because it is unpaid time.
Once the data entry portion of the Title XIX time study is filled out, the information
rolls onto the Title XIX summary page.
Time-Study Data Report for Summary of FFP(v3.1)
AGENCY; Bean Ccanty TIME STUDY PERIOD:July-September(01)
LAST NAME: Smith TIME STUDY MONTH:August
FIRST NAME; I.tary
JOB TITLE: PHPI
SPMP: Yes
TIME BASE: Full-Time
The percentages below are based on the program activities performed by this staff member
and can only be used to invoice for the Fiscal Year and Time Study Period entered above.
Directin—Please em•erthe budget line number,program name,and Medi-Gat Factor(MCF)%for each program the staff umrks in.
For subprograms of MCAH,BIN,AFLP,enter them after the main program name e.g.,MCAH-SIDS
Percentage Distribution of StaffTime by Program
%of
Program Budget time in Medi-Cal
Reference Line t Program Not Matchable Non-Enhanced i Enhanced Program" Factor%
A 1 MCAH 54.20% 17.61% 28.18% 28.03% 62.0%
- - - - ...............................................
. . . . . . . ---------------------------------- - - ------------------ -----------------------
B 2 MCAH SIDS 100.011% 6.37% 62.0%
-------- ----- ------------=--------- --- ------------------ ---------------------
C b BIH 90.32% 9.68% 50.32% 85.0%
-- -- -
D Dther programs 100.00% 1s.29'6
'-'--'-'----......-'------"...........•............... .... ..............................................
E
............'-"---"-'---"-----".................................. ..............................................
F
G
...................................................... ......-".................................... ..................."
H
K
L
Total 100,00 4
This information is to be used by agencies to determine the percentage of staff salap that is billable to MCAH Programs.It can be used by
agencies that do not maintain a daily record of program time.
Once the function codes and program codes are entered for each week, the time
study report calculates the percent of time, by program, that staff is allowed to claim
within four rates of reimbursement. The rates are:
• Enhanced (75/25)— Reimbursement for Medi-Cal administrative activities
performed by a Skilled Professional Medical Personnel (SPMP) and/or
clerical support staff directly supervised by a SPMP that are directly
necessary for the completion of the professional medical responsibilities
and functions of the SPMP. In addition to the qualification of the SPMP
personnel, the activity must require the use of their professional medical
knowledge, training, and/or expertise. The rate of reimbursement is $0.75
for every dollar expended for activities that meet one of the two FFP
objectives.
• Non-Enhanced (50/50) — Reimbursement for Medi-Cal
administrative activities performed by any of the agency's staff. The
rate of reimbursement is $0.50 for every dollar expended for activities
July 2025 17 California Department of
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October 21, 2025
that meet one of the two FFP objectives.
• Not eligible for Title XIX (Unmatched) — Reimbursement for
activities performed by agency staff that meet the requirements of the
Scope of Work but do not meet one of the two FFP objectives. This
may be claimed under Title V, State General Funds or Agency funds.
• Allocated — Reimbursement for costs, which are prorated
according to the ratio of time recorded under the above rates.
Reimbursement Rates & Function Codes
Each rate of reimbursement is unique in its reimbursement formula. Within the four
rates, there are a total of 12 function codes. Each function code has a definable and
unique set of activities that are performed by staff. Consequently, all activities and
paid time-off are identified under the function codes in the appropriate
reimbursement class.
Enhanced Rate
Enhanced rate function codes are reimbursed at the rate of 75/25 and may be used
for salary, benefits, travel costs, training, and possibly subcontract costs.
Subcontractor costs can be enhanced if the subcontractor is a governmental agency
contracted by a governmental agency that time study (Refer to the Budget
Documentation Section, for detailed information). The Enhanced rate covers
activities performed by a SPMP and/or clerical support staff when directly supervised
by a SPMP that are directly necessary for the completion of the professional medical
responsibilities and functions of the SPMP under the following function codes:
Title/DescriptionFunction
Code
2 SPMP Administrative Medical Case Management
3 SPMP Intra/Interagency Coordination, Collaboration &
Administration
6 SPMP Training
8 SPMP Program Planning & Policy Development
9 Quality Management by SPMP
Non-Enhanced Rate
Non-Enhanced rate function codes are reimbursed at the rate of 50/50 for salary,
benefits, training, travel costs, and associated operating expenses. Subcontractor
costs may be reimbursed at a Non- Enhanced rate if Title XIX requirements are met.
July 2025 18 California Department of
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PROCUREMENT AGREEMENT NUMBER: P-25-525
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October 21, 2025
The Non-Enhanced rate covers activities under the following function codes:
FunctionD- • •
Code
1 Outreach
4 Non-SPMP Intra/Interagency Collaboration & Coordination
5 Program Specific Administration
7 Non-SPMP Training
Not eligible for Title XIX (Unmatched Rate)
The unmatched rate function code is for activities included in the Scope of Work
(SOW) that may or may not meet one of the two FFP objectives.
Title/DescriptionFunction
Code
11 Other Scope of Work Activities
Allocated Rate
Allocated rate function codes are to be used by all staff to record usage of any paid
leave other than Compensatory Time Off (CTO), including holiday, vacation, and
sick leave. The allocated activities are covered by the following function codes:
Title/DescriptionFunction
Code
10 Non-Program Specific General Administration: Non-program
specific general administration is prorated between programs
and matchable and unmatchable function codes. The portion
allocated as matchable may only be matched at the Non-
Enhanced rate (50/50).
12 Paid Time Off: Paid Time Off is prorated between programs and
matchable and unmatchable function codes. CMS permits the
matchable amount to be proportionately distributed between the
Enhanced (75/25) rate and the Non-
Enhanced (50/50) rate.
July 2025 19 California Department of
*Public Health
PROCUREMENT AGREEMENT NUMBER: P-25-525
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October 21, 2025
Additional Time Worked
Overtime and/or CTO earned must be recorded to the function code appropriate for
the activities performed. CTO time is recorded when earned, and NOT to be
recorded when used.
.-FP Function Codes
Please note the function codes table has moved to MCAH Administrative Funding
and Fiscal Documents page under Title XIX Function Codes. The Department of
Health Care Services Title XIX Claiming Toolkit is also available to provide
additional guidance and clarification to assist with appropriately documenting and
seeking reimbursement for Title XIX matching funds through interagency
agreements (IAs) maintained between DHCS and the California Department of
Public Health (CDPH), California Department of Social Services (CDSS), and other
state departments.
July 2025 20 California Department of
*Public Health
PROCUREMENT AGREEMENT NUMBER: P-25-525
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FFP (Title XIX) Decision Tree
Title XIX Decision Tree
Is this activity in the MCAH,CHVP, BIH. PEI or AFLP Scope of Work?
YES NO
Code to:
"Other Programs"
Does this activity meet Objective#1 or#2 of the FFP Guidelines?
Objective#1 -Assisting individuals eligible for Medi-Cal to enroll in the PAedi-Cal program'
Objective #2—Assisting members on IvIedi-Cal to access Medi-Cal covered benefits and services*
YES NO
Code to code 11
'Other Activities"
3. Does this activity require the skill, knowledge, and expertise of an SPMP?
YES NO
i i
SPMPs only All staff includinq SPMPs
Code to one of the Code to one of the
following codes: following codes:
2. 3. 6. 8_ or 9 1. 4. 5. or 7
Code 10 Non-Program specific general administration: This code is to be used by staff when
attending an Agency required meeting, training, staff development. etc. (Examples:
Sexual Harassment training, Workplace Violence, IT Security. Any training or meeting that
is mandatory for your employment).
Code 12 Paid time off Sick Leave, Vacation, and Paid Holidays.
"Includes MCAH program activities that support the proper and efficient administration of the Medi-Cal
Program.
Jul 2025 21 ,� California Department of
Y *Public Health
PROCUREMENT AGREEMENT NUMBER: P-25-525
Fresno Interdenominational Refugee Ministries (FIRM)
October 21, 2025
SPMP Requirements: Professional Classification
Policy
The Agency has the responsibility to substantiate claiming based on SPMP status.
The Agency's job class specification must stipulate that the incumbent be from one
of the following classifications and the Program duty statement must reflect
enhanced and non- enhanced activities.
Pursuant to Title 42, Code of Federal Regulations (CFR), Sections 432.2 and
associated State policy, SPMP classifications include the following:
• Physician
• Registered Nurse
• Physician Assistant
• Dentist
• Dental Hygienist
• Registered Dental Assistant
• Nutritionist—with a Bachelor of Science (BS)degree in Nutrition
or Dietetics and registered with the Commission of Dietetic
Registration (RD)
• Licensed Clinical Social Worker with medical specialization or master's degree in
social work
• Licensed Vocational Nurse
• Licensed Clinical Psychologist—with a PhD in psychology
• Licensed Audiologist—certified by the American Speech and Hearing Association
• Licensed Physical Therapist
• Licensed Occupational Therapist— registered by the National
Registry of American Occupational Therapy Association
• Licensed Speech Pathologist
• Licensed Marriage and Family, Therapist)
SPMP includes only professionals in the field of medical care. SPMP does not
include non- medical health professionals, such as public administrators, medical
budget directors, analysts or senior managers of public assistance or Medicaid
programs. Experience in the administration, direction or implementation of the
Medicaid program is not considered the equivalent of professional training in a
field of medical care.
The following are not considered to be SPMP classifications consistent with
federal guidance and state policy:
• Master of Social Work without a Licensed Clinical Social Worker (LCSW) license
• Master of Public Health (MPH)
• Health Education Consultant (HEC)
• Community Health Worker (CHW)
July 2025 22 California Department of
*Public Health
PROCUREMENT AGREEMENT NUMBER: P-25-525
Fresno Interdenominational Refugee Ministries (FIRM)
October 21, 2025
SPMP Requirements Professional Education and Training
Policy
Per 42 CFR, Chapter IV Subchapter C 432.50, for the enhanced FFP rate of 75
percent to be available for expenditures for salary or other compensation, fringe
benefits, travel, per diem, and training for SPMPs, or staff directly supporting such
personnel, the following requirements must be met:
• The activities performed by the SPMP, or staff directly supporting such
personnel, must be necessary for the proper and efficient administration of
the Medicaid State Plan and must not include expenditures for medical
assistance.
• The staff designated as SPMP must have professional education and
training in the field of medical care or appropriate medical practice.
• "Professional education and training" means the completion of a 2-year or
longer program leading to an academic degree or certificate in a medically
related profession (42 CFR 432.2.(d)
o This is demonstrated by possession of a medical license,
certificate, or other document issued by a recognized National or
State medical Iicensure or certifying organization; or
o A degree in a medical field issued by a college or university certified
by a professional medical organization. The activities performed by
the SPMP must require the use of their professional medical
knowledge, training, and/or expertise.
• The staff supporting SPMPs are secretarial, stenographic, and copying
personnel and file and records clerks who provide clerical services that are
directly necessary for the completion of the professional medical
responsibilities and functions of the SPMP.
• The SPMP staff must directly supervise the supporting staff and the
performance of the supporting staff's work.
• The SPMP, and staff directly supporting such personnel, must have a
documented employer- employee relationship.
• The Agency must have a written agreement with the State to verify that the
requirements listed above are met.
Procedure
Review the optional SPMP questionnaire that follows. If you find it would be a helpful
resource, reach out to your Contract Liaison for the most recent version.
Complete the optional SPMP questionnaire to determine the SPMP/non-SPMP
status of an employee. The questionnaire needs to be administered only once,
although periodic repetition may help the Agency to identify changes in staff
education and composition. Retain any completed SPMP questionnaires as part of
July 2025 23 California Department of
*Public Health
PROCUREMENT AGREEMENT NUMBER: P-25-525
Fresno Interdenominational Refugee Ministries (FIRM)
October 21, 2025
the Agency's audit files while SPMP staff are employed with the Agency and through
the documentation retention period.
Example of SPMP Questionnaire
i+.aNn Ca•k•MCV• Skilled Professional Medical Personnel
S Directly Supporting Staff Questionnairf,
PART I: INSTRUCTIONS
Tnis Skilled Professional Medical Personnel (SPNIP) and Directly Supporting Staff(DSS I
questionnaire is intended to be a helpful tool for our state and county partners to utilize in
making determinations as to whether a specific position or classification performing
certain activities qualifies for enhanced SPMP/DSS Title XIX claiming.'
We encourage state and county partners to complete this SPMP/DSS questionnaire and
maintain it as part of the supporting documentation for any enhanced SPMP/DSS Title
XIX claiming.
For additional guidance regarding enhanced Title XIX claiming, please note the
following
• This SPMP/DSS questionnaire is not intended to be a replacement for
applicable federal statutes, regulations. or audits that outline requirements for
SPMP/DSS claiming but instead is adjunctive to those resources. Please review
the applicable federal law (Social Security Act 1903(2XA)) and regulations (Title
42 Code of Federal Regulations (CFR) Section 431. 1 —432 55), excerpted in
relevant part below For the full text, please visit one of the following links
o SSA Section 1903(2)LA), available at:
https-/twwwssa.gov/OP Home/ssact/btIe19/1903 htm.
0 42 CFR Sections 432.1 -432.55, available at:
https://www qpo govlfdsyslpkg/CFR-19%-title42-vol3/pdflCFR-IQQ- itie42-
vol3-part432.pdf.
• Each state and county partner claiming enhanced SPMP/DSS Title XIX
expenditures must maintain supporting documentation evidencing compliance
with applicable federal statutes, regulations and audits
• For more information about enhanced SPMP/DSS Title XIX claiming, please
refer to the Department of Health Care Services (DHCS)document titled "Title
XIX Claiming, Expenditures and Invoicing Frequently Asked Questions.' which
was provided to state partners separately DHCS will also post this document
on the DHCS website
PART II: SPMP CLASSIFICATIONS
Please use the following questions to help determine if you
an employer or supervisor filling the form out on behalf
requirements for enhanced Title XIX funding for SP
inforrhatcr•contained in this document
Mona advice In addition
Jul 2025 24 � California Department of
y *Public Health
PROCUREMENT AGREEMENT NUMBER: P-25-525
Fresno Interdenominational Refugee Ministries (FIRM)
October 21, 2025
SPMP Requirements: Activity
Policy
In addition to the qualifications of the provider meeting SPMP criteria, the activities
performed by the SPMP must require the use of their professional medical
knowledge, training, and/or expertise in order to qualify for enhanced matching
funds.
Work by directly supporting staff is also eligible for enhanced funding when
secretarial, stenographic, and copying personnel and file and records clerks who
provide clerical services that are directly necessary for the completion of the
professional medical responsibilities and functions of the SPMP.
The SPMP staff must directly supervise the supporting staff and the performance of
the supporting staff's work. The SPMP and staff directly supporting such personnel
must have a documented employer-employee relationship.
The local or county partner must have a written agreement with the State to verify
that the requirements listed above are met.
Title XIX Claiming Cover Letter
For invoices claiming enhanced SPMP Title XIX expenditures (including allocated
rates for paid time off), LHJs must submit their invoices using a standardized
detailed description letter and accompanying documentation to substantiate
expenditures billed under the applicable inter-agency agreement. Each state
department or LHJ claiming expenditures under an inter-agency agreement must
submit a Title XIX Claiming Cover Letter (as shown below) which includes the
following information:
July 2025 25 California Department of
*Public Health
PROCUREMENT AGREEMENT NUMBER: P-25-525
Fresno Interdenominational Refugee Ministries (FIRM)
October 21, 2025
ODepartment/County:Bean County
Program Name: Maternal,Child and Adolescent Health(MCAH)
Invoice Number(s):2022XX MCAH Ql ITotal amount of requested Yrtle XIX funding: $ 57,937.17
OFY and Quarter:FY 2022-232022.01 MCAH Ql Period(s)of Service: July-September
2 Direct Services(Types of services provided and to what population;include information about procedural safeguards to assure expenditures billed are only for Medi-Cal services.):
Provided screening and case management services to Medi-Cal eligible children under 6 years of age residing in Bean County.Functions at the county level are used to indicate Medical eligibility;
expenses billed under non-Medi-Cal eligible function codes are not included in this invoice.
4 Other Funds Hours:IN Hours:Enhanced Hours:Allocated
(non-claimable) 50/50 (75/25 (50/50:75/25 Ratio)
Quarter PCA Code(s): PCA Code(s): PCA Code(s): Paid Time Off
Salary 53107&53112 53118 53117
SPMP with Function Code(s: Function Code(s): Function Code(s): Function Code(s):
Eligible Fringe 10 11 1 4 5 7 2.3.6 8 9 12
`3 Name Classification (Y/N) Benefits Time Cost Time% Cost Time% Cost Time% Cost
1 May Trin MCAH Director N $37,736.87 83.2% $31,397.08 16.8% $6,339.79 0.0% $0.00
2 Michael Trinidad MCAH Coordinator Y $52,782.02 51.1-A $26,950.50 44.696 $23,540.78 4.3% $2,290.74
3 Ma Smith Public Health Nurse/SIDS Coordinator Y $27,217.13 61.8% $16,825.63 31.7% $8,627.83 65% $1,763.67
4 Adrianna Lopez Public Health Nurse Y $39,935.18 29.3% $11,697.01 19.7% $7,871.22 51.0% $20,366.94
5 Joanne Park Community Health Worker N $45,260.45 86.0% $38,923.99 14.0% $6,336.46 0.0% $0.00
6 Luke Whitewall Epidemiologist N $34,169A9 83.1% $28,377.76 17.0% $5,791.73 0.0% $0.00
7
8
9
10
Direct Service Expenses $0.00 300.0% $0.00 0.0% $0.00 0.0% $0.00
Indirect Costr $59,275.2 665.0% $3,,540.79 35.0% $20,734.49
Non-Reimbursable Amount $ $0.00 $0.00 $0.00
Total Expenditures 5 $192,712.76 $79,242.31 $24,421.35 $0.00
Title XIX federal funding: $39,621.16 $18,316.01 $0.00
G
Summaryof otherfundin sources used for the Title XIX match,includingsource(e..,County Rea ent Funds,taxes,etc)totaling: $238,439.25
$10,000.00 expended from Bean County 2022 Realignment Fun t$10,225.08 expended from Blue County general fund(including property tax revenue).
I certify underpenalty of perjury that the information provided on this document is true and correct to the best of my knowledge,based on actual expenditures incuaed for the period claim and that
O in
funds provided are in accordance with 42 CFR 433.51.
Approved by: Title: Phone: Email:7
vgn ondprint name
Health and Safety Code Sections 124060(322.2),124060(322.5),124070(323),124075(322.2)are the payment authority. p
Attachment Invoice 8 Page 1 of 1
Instructions for Filling Out the Title XIX Claiming Cover Letter by Section
1. Header - Enter names of state department or county/LHJ and program
(e.g., Maternal, Child, and Adolescent Health), invoice number(s), state
fiscal year and quarter, and period(s) of service covered by the invoice.
2. Direct Services - (Yellow cell in the template) If the invoice includes direct
services, provide information on the types of services provided and to what
Medi-Cal population(s). Include information about procedural safeguards as
to how the claiming state department or LHJ assures that the expenditures
billed are for Medi-Cal members or services only. For example, some
July 2025 26 * California Department of
Public Health
PROCUREMENT AGREEMENT NUMBER: P-25-525
Fresno Interdenominational Refugee Ministries (FIRM)
October 21, 2025
programs use a dedicated billing code at the county level to designate Medi-Cal
eligibility of a service recipient. Please ensure this is completed.
3. Staff Details — For staff providing direct services or support, provide the
following:
a) Names of individual staff persons (no initials, full name is required).
Please ensure you are listing the full names under the personnel cells.
First and Last names should be visible and not truncated. Extending
the cell may be required.
b) Use official state/LHJ classifications and titles (no acronyms for
classifications or titles; Must match duty statements and
organizational charts provided). For SPMP staff with a
Director/Coordinator/Supervisory classification, please add Public
Health Nurse, Registered Nurse, etc.
c) Names and classifications— Please ensure all name and classification
columns are wide enough to accommodate all the words. You may
extend the cell/s if necessary.
d) SPMP eligibility status, to be consistent with the Code of Federal
Regulations (CFR), Title 42, https://www.ecfr..qov/current/title-
42/chapter-IV/subchapter- C/part-432 State Personnel
Administration:
i. "Skilled professional medical personnel means physicians,
dentists, nurses, and other specialized personnel who have
professional education and training in the field of medical care or
appropriate medical practice and who are in an employer-
employee relationship with the Medicaid agency. It does not
include other nonmedical health professionals such as public
administrators, medical analysts, lobbyists, senior managers or
administrators of public assistance programs or the Medicaid
program." (Excerpted from 42 CFR Section 432.2, emphasis
added.)
Note: Consistent with federal guidance, DHCS interprets medical
care and practice strictly in accordance with 42 CFR Section 432.50,
Subsection (d).
ii. "Directly supporting staff means secretarial, stenographic, and
copying personnel and file and records clerks who provide
clerical services that directly support the responsibilities of
[SPMP], who are directly supervised by the [SPMP], and who
are in an employer-employee relationship with the Medicaid
agency." (Excerpted from 42 CFR Section 432.2.)
e) Monthly salary, with fringe benefits.
4. Hours — Non-Claimable, Non-Enhanced, Enhanced, and Allocated Paid
July 2025 27 California Department of
Public Health
PROCUREMENT AGREEMENT NUMBER: P-25-525
Fresno Interdenominational Refugee Ministries (FIRM)
October 21, 2025
Time Off (PTO)
a. PCA and function codes should be those assigned to the
services for each column. Note: Please attach forDHCS'records
standard detailed descriptions of the reimbursable activities that
fall under each PCA/function code claimed as an expenditure. A
brief list of function names is not sufficient.
b. Percentage of time worked per category of non-claimable or
claimable function, from the period(s) of service for the invoice(s)
summarized.
Note: The calculation for Paid Time Off (PTO) is a weighted average
that automatically calculates based upon the percentages of time the
employee worked on Non- Claimable, Non-Enhanced, and
Enhanced activities. For example, if an employee spent all of their
work time performing Non-Enhanced activities, their paid time off will
also be at the Non- Enhanced rate. However, if the employee spent
only one-half of their time in the office at the Non-Enhanced rate,
only one-half of the paid time off will be reimbursed at the Non-
Enhanced rate.
Please also note that the allocated cost of each employee's PTO is
immediately visible at only its reimbursable portion, whereas the
cost columns for Non- Enhanced and Enhanced activities show the
total labor cost in each row and prorate to the reimbursable portion
at the bottom, next to "Title XIX federal funding." Accordingly, the
costs within each row may not add up to 100 percent of that
employee's salary if any percent of their time is being reimbursed at
the allocated rate for PTO. This does not indicate an error.
The percentage of time worked for each row must include at least
one number above zero in order for the automatic calculations to be
correct. The default is to have 100 percent in the Hours: Non-
Claimable column. Any TXIX cover sheet that includes excel value
errors (#VALUE!) must be corrected by removing the zero under
the "Total Wages" and/or "Actual Benefits" on the quarterly invoice
tab.
c. Direct service expenses.
d. Indirect/ operating expenses (if allowed under the appropriate
inter- agency agreement) are ineligible for enhanced or allocated
rates.
5. Total amount of Title XIX federal funding being requested — These
cells will automatically calculate subtotals for enhanced, non-enhanced,
and allocated rates. The overall total federal funding requested appears at
the top right of the cover letter
6. Summary of non-federal expenditures (Yellow cell) used for matching
the Title XIX reimbursement. Please describe the qualifying expenditures,
July 2025 28 California Department of
*Public Health
PROCUREMENT AGREEMENT NUMBER: P-25-525
Fresno Interdenominational Refugee Ministries (FIRM)
October 21, 2025
including source (e.g., County Realignment Funds, taxes, etc.), in the box
provided.
7. Approval —Sign and print name on printed copy. Please include official
classification title (no acronyms), phone number, and email address.
8. Page numbers — Please add the current and total page numbers for the
invoice submittal package. If the number of the employees for the
invoice(s) summarized exceed the space on a single cover letter, include
subsequent pages.
Additional guidance on Title XIX funding for your reference:
• CMS State Operations Manual available at cros.gov.
• Medicaid Administrative Claiming available at medicaid.gov.
• CMS Regulations & Guidance available at cros.gov.
July 2025 29 California Department of
*Public Health
PROCUREMENT AGREEMENT NUMBER: P-25-525
Fresno Interdenominational Refugee Ministries (FIRM)
October 21, 2025
Attestation Form
This form certifies that SPMP criteria for all enhanced classifications have been met.
In addition, the form must be dated, completed in its entirety, and signed by
authorized staff who have signing authority. Signing authority is defined as the
person listed on your Agency Information Form (AIF) which was submitted with your
AFA package, dated, boxes checked, and returned MCAHFinAct(a_)_cdph.ca.gov with
a Cc to your Contract Liaison. This form only needs to be submitted at the beginning
of the fiscal year with your AFA package, however, if there are changes within SPMP
staffing, a new form must be submitted to your Contract Liaison.
C D P H Health and Human Services Agency
California Department of Public Health QO
Erica Pan,MD, MPH Gavin Newsom
Director and State Public Health Officer Governor
Attestation of Compliance with the Requirements for Enhanced Title XIX Federal Financial
Participation (FFP) Rate Reimbursement for Skilled Professional Medical Personnel (SPMP)
and their Direct Clerical Support Staff
In compliance with the Social Security Act(SSA) section 1903(a)(2), Title 42 Code of Federal
Regulations(CFR)part 432.2 and 432.50, and the Federal and State guidelines provided..
has determined that the list of individuals in the attached Exhibit A are eligible for the enhanced
SPMP reimbursement rate, for the State Fiscal Year based on our review of all the criteria
below:
V Professional Education and Training
❑ Job Classification
❑ Job Duties/Duty Statement
❑ Specific Tasks (if only a portion will be claimed as SPMP enhanced functions)
❑ Organizational Chart
❑ Accurate, complete, and signed SPMP Questionnaire
❑ Active California License/Certification
❑ The undersigned hereby attests that he/she:
• Has personally reviewed the criteria above and its supporting documentation and determined
that the individuals meet the federal requirements for the enhanced SPMP reimbursement
rate.
• Will maintain all the aforementioned records and supporting documentation for audit purposes
for a minimum of 3 years.
• Certifies that SPMP expenditures are from eligible non-federal sources and are in accordance
with 42 CFR Section 433.51
• Understands that if SPMP requirements are not met, the agency will be financially responsible
for repaying the costs to the California Department of Public Health (CDPH)
• Understands that CDPH may request additional information to substantiate the SPMP claims,
and such information must be provided in a timely manner.
Agency Name/Local Health Jurisdiction
Name and Title Signature Date
Jul 2025 30 � California Department of
y Public Health
PROCUREMENT AGREEMENT NUMBER: P-25-525
Fresno Interdenominational Refugee Ministries (FIRM)
October 21, 2025
Medi-Cal Percentage (MCP)
Policy
Title XIX FFP funds are intended to reimburse agency costs for time spent doing
certain administrative activities that benefit Medi-Cal members exclusively.
However, Program activities are generally performed for both Medi-Cal members
and the general population. Therefore, it is necessary to use a base MCP to identify
what portion of the general population receiving services are Medi-Cal members. A
program's MCP is the percent of the primary target population served by the
program that are current Medi-Cal beneficiaries.
The purpose of this section is to clarify policy and requirements regarding calculation,
documentation, approval, and use of a base MCP for the BIH, AFLP, CHVP, PEI and
MCAH Program.
Base Medi-Cal Percentage
The Base MCP is the number of Medi-Cal births divided by the total number of
live births for a region. It is re-calculated when new birth data is available.
AFLP Base Medi-Cal Percentage
AFLP's base Medi-Cal Percentage MCP is calculated by CDPH/MCAH for each
AFLP agency using their client data entered in the software information system
provided by the Program Consultant.
BIH Program Base Medi-Cal Percentage
The BIH Base Medi-Cal Percentage MCP is calculated by CDPH/MCAH for each
BIH Agency using data from the BIH MIS Current Pregnancy Report (statewide
aggregate data) and the BIH pregnant individuals from the prior calendar year. Each
BIH Agency must use the MCP posted on the BIH Base MCP table.
MCAH Program Base Medi-Cal Percentage
The MCAH Base MCP is calculated by CDPH/MCAH for each MCAH Agency using
data compiled from the Birth Statistical Master File to derive the percent of Medi-Cal
paid births to total County live births. Each MCAH Agency can use the MCP posted
on the MCAH Base MCP table.
Besides using the MCAH Base MCP posted by CDPH/MCAH, the MCAH Medi-Cal
Percentage can also be any of the following:
1. A Local MCP determined by the Agency, approved by CDPH/MCAH,
and used for some or all staff.
July 2025 31 California Department of
*Public Health
PROCUREMENT AGREEMENT NUMBER: P-25-525
Fresno Interdenominational Refugee Ministries (FIRM)
October 21, 2025
2. Factoring two or more Medi-Cal Percentages MCP for one staff
(multiple or weighted MCP).
3. Variable Medi-Cal Percentages MCP for staff dependent on their actual client
contacts.
Note: When performing client counts for any of the above alternate methods,
Medi-Cal members with a Share of Cost (SOC) can be included in the Medi-Cal
enrolled client counts.
When a MCAH Agency uses an MCP other than the MCAH Base MCP,
supporting documentation is required to substantiate the invoiced MCP. If an
audit reveals that the documentation does not support the invoiced MCP, the
Agency will be responsible for repayment of the difference between the invoiced
amounts and the amounts the documentation supports. If there is no supporting
documentation, the repayment amount will be calculated based on the MCAH
Base MCP.
Local Medi-Cal Percentage MCF
An Agency may have access to more current or region-specific final birth data and
can use an alternate Local MCP for some or all of their staff. Local MCPs must be
reviewed and approved by CDPH/MCAH each fiscal year they are used.
To use a Local MCP an Agency must:
1. Submit with the Agreement Funding Application (AFA), via the
Budget Template (I) Justification worksheet, the data source(s) and
methodology used for the calculation(s).
2. Calculations need to be based on population-wide, publicly available
(posted on the city or county website) and statistically valid data.
3. Maintain the data sources, methodology, CDPH/MCAH approval,
client counts and any other supporting documentation for audit
purposes.
When proposing a Local MCP, the data source(s) and methodology must be
submitted to CDPH/MCAH for approval each fiscal year.
Multiple Medi-Cal Percentage MCP For Single Staff
In some instances, Agency staff duties can be divided into two or more specific
areas of responsibility. Each area is based on a different function, activity, or client
contact, and stated on two or more budget and invoice lines. For example, a MCAH
Director performs 60% general administrative MCAH Director duties and 40%
Perinatal Services Coordinator (PSC) duties. The Director could be listed on two
budget and invoice lines with one line stating 60% FTE as the MCAH Director
performing administrative functions using the CDPH Base or Local MCP; and on
the second line 40% FTE performing PSC duties claiming up to 95% MCP.
The Comprehensive Perinatal Services Program (CPSP) is a Medi-Cal program;
therefore a Medi-Cal Percentage MCP of up to 95% may be claimed for a PSC.
Specific activities of the PSC will determine the percent of FFP match with each time
July 2025 32 California Department of
*Public Health
PROCUREMENT AGREEMENT NUMBER: P-25-525
Fresno Interdenominational Refugee Ministries (FIRM)
October 21, 2025
study period.
The duty statement of the PSC must describe the activities assigned to that position
including activities that qualify for FFP.
To use Multiple Medi-Cal Percentage MCP for the same staff an Agency must:
1. Submit with the AFA, via the Budget Template (1) Justification
worksheet, the data source(s) and methodology used for the
calculation(s).
2. Verify each fiscal year that there were no data changes or shifts in
workload. If there are changes, an updated methodology needs to be
submitted for CDPH/MCAH review and approval each fiscal year.
3. Maintain the methodology, CDPH/MCAH approval, client counts, supporting
documentation, and any other substantiating documentation for audit
purposes.
Weighted Medi-Cal Percentage
Only MCAH Directors and Coordinators can use a "Weighted" MCP. A Weighted
MCP must be approved by CDPH/MCAH. The weighted MCP is a projection
factoring the expected FTEs and MCPs. You will invoice using the actual FTE
based on the time studies and MCPs based on actual client counts for that quarter.
The Weighted MCP is based on time (% FTE) spent in managing varying programs
or entities that have a higher MCP than the MCAH Base or Local Medi-Cal
Percentage.
The Weighted MCP is calculated by adding the sums of the MCP multiplied by the
percentage of time performing activities in a program. For example:
Activity/Program • • - • MCP
CPSP .1 FTE x 95% 9.5%
High Risk Visiting Program .2 FTE x 80% 16.0%
General MCAH Work .7 FTE x 52% (Base MCP) 36.4%
(MCP on Budget) 1.0 FTE �61.9%
To use a Weighted MCP an Agency must:
1. Complete the Weighted MCP table located at the bottom of the
(1) Justification worksheet within the MCAH Budget Template.
2. Submit with the AFA via the MCAH Budget Template (1) Justification
worksheet, the data source(s) and methodology used for the
calculation(s).
3. Verify each year that there were no data changes or shifts in workload. If
there are changes an updated methodology needs to be submitted for
CDPH/MCAH review and approval each fiscal year.
July 2025 33 * California Department of
*Public Health
PROCUREMENT AGREEMENT NUMBER: P-25-525
Fresno Interdenominational Refugee Ministries (FIRM)
October 21, 2025
4. Maintain the data sources, methodology, CDPH/MCAH approval,
client counts, and any other supporting documentation for audit
purposes.
Variable Medi-Cal Percentage
MCAH Agency staff whose job duties and duty statement specify that they work
with a unique population are permitted to use Variable MCPs. A Variable MCP is
one that varies each quarter and is based on 100% client counts during the time
study month for that quarter.
The Variable MCP is determined each quarter using one of the following methods:
1. The total number of clients seen with documented Medi-Cal
member identification numbers, divided by the total number of
clients served by a specific staff member.
2. An Agency with a specialized program may determine a Variable MCP
based on data for the entire program. If CDPH/MCAH approved, all
staff working in that program can use the same Variable MCP.
During an Agency's time study month each staff claiming a Variable MCP must
document 100% of their client contact as either "non Medi-Cal" or "Medi-Cal" in
their supporting documentation. "Medi- Cal" does not mean assumed eligibility. A
client must be a current Medi-Cal beneficiary. Supporting documentation must be
able to substantiate a client's Medi-Cal enrollment status in the event of an audit.
When budgeting Variable Medi-Cal Percentage for individual staff an Agency
is proiectinq what the FYs ratio of Medi-Cal enrolled to total client contact will be
for that specific staff. Budget projections should be based on prior year actual
client counts and staff duty statements.
Invoicing with Variable Medi-Cal Percentage must reflect actual client counts
for that claiming period and client count documentation must be maintained for a
minimum of seven years for audit purposes. This documentation will be reviewed
during an on-site audit, and copies can be requested at any time by CDPH/MCAH
staff to substantiate an Agency's Variable MCP. If a client's Medi-Cal enrollment
cannot be verified, they cannot be counted as Medi-Cal enrolled.
Documentation of client counts to support Variable MCP must identify the following:
1. Staff name and position/title
2. Date and time span of activity
3. Activity and nature/intent of activity (e.g., outreach at health fair)
4. Total number of"clients" seen or contacted
5. Documented Medi-Cal verifications (e.g., member's Medi-
Cal identification numbers)
To use a Variable MCP for one or more staff an Agency must:
1. Submit with the AFA via the MCAH Budget Template (I) Justification
worksheet the data source(s) and methodology used for the
calculation(s).
July 2025 34 * California Department of
*Public Health
PROCUREMENT AGREEMENT NUMBER: P-25-525
Fresno Interdenominational Refugee Ministries (FIRM)
October 21, 2025
2. Staff or Program need to document 100% of their client contact as
either Medi-Cal enrolled or not in their supporting documentation
during the time study month. Verification of client enrollment status
needs to be maintained for audit purposes.
3. Calculate MCP as a percent using the number of Medi-Cal enrolled
clients to the total clients seen by a staff member for the quarter being
invoiced. Use that MCP for the corresponding quarterly invoice for
that staff member.
4. The actual client counts must be re-calculated each quarter for each quarterly
invoice.
5. Maintain the data sources, methodology, quarterly calculation
summaries, client counts, CDPH/MCAH approval, and any other
supporting documentation for audit purposes.
MCAH Director - Medi-Cal Percentage (MCP)
Policy
The Division's intent is to assure that all pregnant women and their children can
obtain quality maternal and child health services in the State of California. The
MCAH Director is responsible for overseeing local MCAH staff and activities that
carry out this mission. It is important that the MCAH Director's MCP be
representative of the target population being served.
LHJs can augment their Programs' funds using FFP, which provides federal funding
(Title XIX) for certain activities that:
• Assist individuals eligible for Medi-Cal to enroll in the Medi-Cal program
• Assist members on Medi-Cal to access Medi-Cal services
Reimbursement of costs for matchable activities and related expenses is based on
time spent by qualified staff performing matchable activities on behalf of Title XIX,
Medi-Cal beneficiaries only. A Program's MCP is the percent of the primary target
population served by the program that are current Medi-Cal beneficiaries.
I)rocedure
The local jurisdiction's MCAH Director Medi-Cal percentage, the MCP may be
determined by one of three different methods:
• Using the CDPH/MCAH Base MCP Table — CDPH/MCAH calculates the
percent of Medi-Cal beneficiaries in the population of each local health
jurisdiction based on the Medi-Cal paid delivery and birth data from the
previous calendar year. The MCAH Director is allowed to time study all
activities performed in the MCAH program time using the CDPH/MCAH's
Base MCP for reimbursement.
• Using a locally determined MCP — This is a locally determined
MCP based upon population wide, publicly available or documented
data (Local Base MCP), or direct documentation of Medi-Cal
July 2025 35 * California Department of
*Public Health
PROCUREMENT AGREEMENT NUMBER: P-25-525
Fresno Interdenominational Refugee Ministries (FIRM)
October 21, 2025
beneficiary's identification numbers (Variable MCP).
• Using more than one MCP — The MCAH Director may be responsible for
overseeing local MCAH staff and activities in more than one MCAH
program. The MCAH Director is allowed to time study to each specific
MCAH program (such as MCAH, CPSP, FIMR, Education/Outreach and
Dental) and use the MCP for each of these programs for claiming purposes.
Each program can be budgeted and invoiced on separate lines in the
MCAH Budget and Invoice template.
Requirements
Prior written approvals from the MCAH Program Consultant and Contract Liaison
are required to claim an MCP different from the one listed in the CDPH/MCAH's
Base MCP Table. Role and responsibilities for participation or oversight of local
jurisdiction MCAH or MCAH-related programs must be addressed in the MCAH
Director's duty statement.
Local jurisdictions must determine the percent of time spent per program based on
actual time documented for activities/programs on the CDPH/MCAH approved Time
Study. The MCAH Director must include 100% of their work time on the time study
including time worked outside of MCAH related programs.
All data sources and methodology used to determine the MCAH Director MCP must
be maintained for seven years for audit purposes. The audit file must be maintained
until the records retention schedule for the same audit period expires.
Note: If a State or Federal audit is performed in which there are findings resulting from
the data or methodology used to determine the MCAH Director's MCP, the local
jurisdiction is solely liable for any financial recovery and/or penalties as a consequence
of the findings.
July 2025 36 California Department of
*Public Health
PROCUREMENT AGREEMENT NUMBER: P-25-525
Fresno Interdenominational Refugee Ministries (FIRM)
October 21, 2025
MCP Annual AFA Justification letter
Policy
Agencies must submit a signed justification letter, which provides the rationale for
your intended MCP percentages if utilizing a MCP other than base. This letter must
be on county letterhead and include your justification in claiming each of the various
MCPs that are being requested on your budget. The letter will not replace the MCP
justification area for personnel on the budget template. We have provided an
example letter for your reference titled "Bean County" letter.
Bean County
Maternal, Child and Adolescent Health
May 21, 2021
Angelica Jimenez-Bean
PO Box 000 MS-0000
City of Beans; CA 900000-000
To CDPHIMCAH,
Bean county is using the following Medi-Cal Factors(MCF}for this Fiscal Year(FY)
21122, which includes the justifications-
MCF%J us tificab on
VCF Type
Maximum characters=1024
Variable Direct documenta'ion&number anc parcen'o'%ledi-Cal eligible served on file
Local Actual percentage of Medi-Cal clients participating in program dung 2018-2019_
Weighted Oversees pragrarrms targeting MediCal eligible women of childbeanng age and high nsk
infanWchiidren needing MediCal services.
MuWple Oral Health Care Coordination will be serving the Medical population in access and ensuring
Denti-Cal clients are seeking Preventative and restorative dental care
Base NIA
Sincerely,
Angelica Jimenez-Bean
Bean County MCAH Director
July 2025 37 California Department of
Public Health
PROCUREMENT AGREEMENT NUMBER: P-25-525
Fresno Interdenominational Refugee Ministries (FIRM)
October 21, 2025
Title V 30/30 Earmarking
Overview
Pursuant to Title V of the Social Security Act, Section 505, CDPH is mandated to
provide oversight in the expenditure of Federal MCH Title V Block Grant funding.
Federal MCH Title V Block Grant funding is the key source of support for promoting
and improving the health of all mothers and children, including children with special
health care needs.
Requirements
As required by Federal regulation, CDPH is required to track and utilize all Federal MCH
Title V Block Grant funding as follows:
• At least 30% of Federal MCH Title V Block Grant funds
received are to be expended for Preventive and Primary
Care Services for Children (PPCSC)
• At least 30% of Federal MCH Title V Block Grant funds received are to
be expended for Children & Youth with Special Health Care Needs
(CYSHCN) to provide and promote family-centered, community-
based, coordinated care and to facilitate the development of
community-based systems of services for such children and their
families
• 30% (Other) MCAH activities
• 10% Administrative costs
Title V Time Studies
Currently, only the MCAH Program is required to report Title V expenditures to be in
compliance with Federal regulations. SIDS activities can be coded to Category I
and FIMR should be coded to Category III.
Note: This time study is required and separate from the Title XIX time study.
Title XIX time study must be submitted with the quarterly invoice and Title V
time studies must be submitted no later than the month following invoice
submittal.
Time Studies must be performed for one full month during each of the fiscal quarters
listed below.
• July — September
• October— December
• January— March
• April — June
Each agency will designate in their AFA the month in each quarter that Title V 30/30
Earmarking Time Studies are to be completed. Agencies must communicate their
selected month to the MCAH Program upon receipt of the first quarter time study.
July 2025 38 California Department of
*Public Health
PROCUREMENT AGREEMENT NUMBER: P-25-525
Fresno Interdenominational Refugee Ministries (FIRM)
October 21, 2025
Budget Documents
Overview
Budget documents form the basis for Agency payments and fiscal accountability for
audit compliance. All expenses shown on the budget documents must directly relate
to the accomplishment of the goals, objectives, activities, timelines and outcomes
identified under the Program(s) Scope of Work (SOW).
The Program Budget/Invoice template contains all the necessary documents for
submitting a proposed budget.
GUIDE ORIGINAL = m Justification (II-V)Justifications m Q1 TXDC m Q2 TXX •
Justification worksheets are incorporated in the Budget/Invoice template file to
allow agencies to document explanations of each expense listed under Personnel,
Operating Expenses, Capital Expenditures and Other Costs. Justifications must
include all particulars as specified by CDPH/MCAH for evaluating the necessity or
desirability of each expenditure. This portion of the Program Budget Document is
used for monitoring and auditing purposes.
The budget and corresponding justification worksheets are a required component of
the final approved AFA.
.budget/Invoice Template
BUDG&TSUMMAFtY FGGLY6IR YYGIQ�T BUGC6TSTATYi I auxeT
70t9.10 IORiOiNAL ACTIVE a e
�-w-- Fmmal.cNrrteae ram. ix
M[MN IN'Y1.1R5 [=iGNrtf03 '
A a a M! fR ml �fA IN m fm�r.c.,�
N..rtwlw X muv % top % aR % ,xx. e %
Al1IpCAROx1!] nm f.ao om
III f4kSONNI p am ♦w
Pn OP[-.-r11P[xws a0a pap ]pp 0!0
1101 CAPFtft EMPE""RES om am om ow ox o.m
ptry orxtx lnss am pm
(IJ IN61RFri—T% pap pW
BUDGET TOTALS' a.N 4m QN oN 0.N Rm ►-N n.N
Alufegq 000 ON 0.00
TOTAL TITLE oN
TOTAL SIDS ON OM
TOTAL TITLE XDt
TOTAL AGENCY FUNDS _per,p ON
$ - MaXIMUM Amount Payable from Slat
fI NA9NFN IYNl9lfFlf Itll f11YNT1 LWR 1M1lN Al l x!'AH 11f1vM91MIM AYp1'IYl'YM11
Note: Contact your Contract Liaison if you are having any difficulty accessing the
Budget/Invoice template.
Within the Budget/Invoice template are cells shaded in yellow. These cells will accept
data entry.
July 2025 39 * California Department of
*Public Health
PROCUREMENT AGREEMENT NUMBER: P-25-525
Fresno Interdenominational Refugee Ministries (FIRM)
October 21, 2025
Note: Some of the yellow shaded cells within the Federal/Agency Non-Enhanced
column under the Operating Expenses and Other Charges line items contain
automatic calculations that may be overridden to reduce percentages if
necessary. All other cells are locked, and password protected to prevent
accidental entries. Any unauthorized changes made to the original format will
require a resubmission by the Agency.
Agencies must ensure that the most current approved version of the Program
Budget/Invoice template file is used at all times. The template version is located at
the top of the Budget Worksheet in the cell above the Program name.
esan5. UOa uA
loqfam: Maternal,Child and Adoiescent Health(MCAH)
yrool: Selec4..................
SUM
• All other data (non-shaded cells) are calculated by formulas embedded in the
worksheet cells.
• The allocation amount(s), the Indirect Cost Rate (ICR) percentage
and application and the Base MCP will automatically populate when
the agency name is selected on the Budget Summary Page.
• Funding totals are automatically calculated and forwarded from each
of the detail sections (Personnel, Operating Expenses, Capital
Expenditures, Other Costs, Indirect Costs, and Operating Expenses)
to the Budget Summary Page.
• Negative balances (or red), with the exception of agency funds, are
not allowed on any budget or invoice summary page.
• The total balance shown on the Budget Summary Page cannot reflect a negative
balance.
Budget Summary
The Budget Summary Page contains the following expense categories:
I. Personnel EXPENSE CATEGORY
II. Operating Expenses (1) PERSONNEL
(II) OPERATING EXPENSES
III. Capital Expenditures (Major Equipment) (m) CAPITAL EXPENDITURES
IV. Other Costs (ft') OTHER COSTS
V. Indirect Costs I%') INDIRECT COSTS
r rocedure
The following provides information on formatting, inputting & submission procedures:
• The California Fetal Infant Mortality Review Plus (CA FIMR+) and
Sudden Infant Death Syndrome (SIDS) programs are funded by
Title V and cannot be reimbursed with Title XIX funds.
July 2025 40 California Department of
*Public Health
PROCUREMENT AGREEMENT NUMBER: P-25-525
Fresno Interdenominational Refugee Ministries (FIRM)
October 21, 2025
• Agencies cannot use federal funds derived from any other entity for the
purpose of Title XIX reimbursement.
• The print command will automatically generate the Budget Summary
Page and budget detail pages; however, you must select each
justification worksheet individually to print.
• Each Program Budget/Invoice template file is used for both
budgeting and invoicing purposes. Submit budget documents via
email for each MCAH funded Program.
• Once the budget documents are approved by CDPH/MCAH, the budget
must be signed by the Agency's Program Director and Fiscal Agent (Not
applicable to clarify CBOs or CHVP).
• The Excel version of the Budget/Invoice template file must be sent via
email to the Contract Liaison.
• Submit a scanned signed copy of the budget via email to your Contract
Liaison. Electronic signatures are acceptable.
(1) Personnel
Personnel Costs are listed as the first
line item on the Budget and Invoice (1) PERSONNEL DETAIL
Summary Page. The Personnel Detail TOTAL PERSONNEL COSTS 0.00
FRINGE BENEFIT RATE 1 0.00
Section is titled 'T" and is located after TOTAL VAGES 000
FULLANNUAL
the W. Indirect Costs Detail Section." (Firs[Nme^Last Name) TITLE`N Aeron'ms)SSIFICATION XFTE SALARY TOTAL VAGES
The Personnel Detail Section needs
to be completed prior to all other 11 000
sections within the budget worksheet 5 0.00
in order for the template to auto
calculate for matching purposes.
Staff name, job title or classification, FTE, the average fringe benefit rate and annual
salary entered in the Personnel Detail Section of the budget will populate the (1)
Justification worksheet. Agencies may not go over the salary cap limitation imposed
by the Health Resources & Services Administration.
Total costs from the Personnel Detail Section will populate the Personnel line item on
the Budget Summary Page.
Requirements
The requirements of the Personnel Detail Section are:
• All Program staff, regardless of time worked in the program, or funding
source (unless included in indirect expense line items), must be included
in the Personnel Detail Section.
• Personnel listed in the Personnel Detail Section must meet all applicable
program policies and requirements as detailed in the Program Policy and
Procedure Manual. You must also ensure that you insert full names, no
abbreviations, and that cells are not truncated.
• Anticipated salary increases must be included in the initial preparation
July 2025 41 California Department of
Public Health
PROCUREMENT AGREEMENT NUMBER: P-25-525
Fresno Interdenominational Refugee Ministries (FIRM)
October 21, 2025
of the Personnel Detail Section.
• Vacancies must be budgeted at middle salary range.
• CDPH/MCAH allows reimbursement for fringe benefits that meet each of the
following criteria:
o Necessary and reasonable for the performance of the Program
Agreement and budget
o Determined in accordance with Generally Accepted Accounting
Principles
o Consistent with policies that apply uniformly to all activities of the
Agency
• Fringe benefits may include, but are not limited to:
o Health plans (i.e., health, dental and vision)
o Unemployment insurance
o Worker's compensation insurance
• Fringe benefits do not include:
o Compensation for personnel services paid currently or accrued by
the Agency for services of employees rendered during the term of
this agreement which is identified as regular or normal salaries and
wages, vacation, sick leave, holidays, jury duty and/or military
leave
o Incentive or bonus pay
o Relocation allowances
o Hardship pay
o Cost-of-living differentials
• Travel
o Travel column has been added to the Personnel Detail section in the
budget template. For budgeting purposes, the staff members who will
be traveling will have to select the "X" from the drop down. This will
also help average the Match % allowed in the Operating Expenses
section for Travel.
Procedure
List each staff's first and last name and their job title or classification in the appropriate
column. Note: Job titles and classifications should be consistent with all duty statements
and organization charts.
Enter"VACANT" in the name column if the position is vacant.
• Enter percent of Full Time Equivalent (FTE) for each employee.
• Enter the total annual salary for employees as if they were employed full time.
• Once the FTE and annual salary are entered for an employee, the total wages will
populate.
• Insert an average fringe benefit rate that will be applied to the total
wages listed in each column. A fringe benefit rate is the cost of an
July 2025 42 California Department of
*Public Health
PROCUREMENT AGREEMENT NUMBER: P-25-525
Fresno Interdenominational Refugee Ministries (FIRM)
October 21, 2025
employee's benefits divided by their total wages.
• Enter the non-enhanced and enhanced percentages based on
historical time study data. The combined total of non-enhanced and
enhanced percentages should not exceed the allowable MCP for each
staff person. If the percentages do exceed the MCP, the cell containing
the MCP will turn red. Adjustments to the non-enhanced and enhanced
percentages will need to be made until they are at or below the MCP.
• Travel costs are automatically matched at the Non-Enhanced rate,
based on the "Percent of Personnel Matched". Agencies electing to
enhance travel costs must determine the allowable percentage or
amount in accordance with FFP requirements.
(1) Personnel Justification Worksheet
• Choose Program name from the dropdown selection in column "I."
(e.g., MCAH, FIMR, SIDS, AFLP, BIH).
• The Base MCP percentage will auto populate under the MCP% column for
all staff. If the MCP type is variable, weighted, multiple, or local, enter the
appropriate MCP percentage and select the corresponding MCP type from
the dropdown menu.
• For the current Fiscal Year MCP rates please refer to the
Agreement Funding Application instructions.
Note: When selecting a Multiple MCP type (two or more lines for one staff), you
must complete the "MCP % Justification" column.
• When selecting a Weighted MCP you must complete the Weighted
MCP Calculation Table (located below the MCP Requirements on
the (I) Justification Worksheet), in addition to providing written
justification in the "MCP % Justification" column.
• Enter the MCP justification for each staff when using (or projecting for
Variable MCPs) an MCP higher than the base. Include source data if
applicable, i.e. Penelope software for AFLP. Justification cannot exceed
1024 characters.
• The MCP percentage entered under the justification worksheet will
populate in column 16 of the Personnel Detail Section.
Operating Expenses
The Operating Expenses Detail Section is comprised of three expense areas listed
under the main expense category:
• Travel
• Training
• Operating Expenses (Other than Travel and Training, lines 1-15)
The total dollar amounts from the Operating Expenses Detail Section will populate
the Budget Summary Page.
Operating expenses (other than travel and training) are automatically distributed
July 2025 43 * California Department of
*Public Health
PROCUREMENT AGREEMENT NUMBER: P-25-525
Fresno Interdenominational Refugee Ministries (FIRM)
October 21, 2025
to the Title V and Non-Enhanced Combined Federal/Agency columns according
to how personnel costs are distributed (Percent of Personnel Matched). Lines 1
through 15 of the Operating Expense Detail Section cannot exceed the Percent
of Personnel Matched. Some travel and training costs may be manually
distributed to the Enhanced combined Federal/Agency columns if it is in
accordance with FFP requirements.
The distribution of these costs can be changed as needed by manually entering
new percentages into the percent columns. The allowable Percent of Personnel
Matched for operating costs that are Title XIX reimbursable can be found in the
Percent of Personnel Matched box located in column 16.
Travel
Travel costs are listed on the budget for all staff who travel to conduct Program
business and to attend conferences and training that is directly related to the
objectives described in the SOW.
The cost of travel cannot exceed the established State rates noted in the State
Travel Reimbursement Information on the CalHR website.
For County/Local Health Jurisdictions Only:
Mileage:
Local health jurisdictions may use their county/agency mileage rate as
long as they can provide documentation to substantiate the rate. If the
county/agency does not have a county/agency mileage rate, then they
must provide documentation to show how the rate included in their
allocation agreement was derived. This rate will then be dependent on
State approval and will require support documentation when invoices are
submitted.
Lodging:
If lodging cost exceed the posted amount in the State Travel
Reimbursement Information section, then the traveler must request and
submit an Excess Lodging Rate Request form to the state. This request
must be submitted two weeks prior to the start of travel and approved by
the State. The State may not be able to honor requests submitted after the
start of travel.
Out-of-State travel is allowed for agency leadership to travel to the following national
conferences, including but not limited to:
• Annual meetings of the Association of Maternal and Child Health
Programs (AMCHP)
• Center for Disease Control and Prevention's MCAH Epidemiology Conference
• Annual CityMatCH Conference
Travel to other national conferences may be approved on a case-by-case basis and
requires prior written MCAH approval. All requests must be submitted in writing via
email to your Contract Liaison and Program Consultant with a brief description that
July 2025 44 California Department of
Public Health
PROCUREMENT AGREEMENT NUMBER: P-25-525
Fresno Interdenominational Refugee Ministries (FIRM)
October 21, 2025
includes the items listed below:
• Name and date(s) of the conference, training, meeting, etc.
• Name and title of the individual(s) traveling
• Necessity of the trip, how it relates to the goals and objectives of the SOW
and how it improves the skills of the attendee
• Travel location and dates
• Breakdown of the proposed costs of the trip
Out-of-State travel must be identified in the training area of the (ll-V) Justifications
worksheet of the budget and under the appropriate goal and objective in the SOW.
Travel costs are automatically matched at the Non-Enhanced rate, based on the
Percent of Personnel Matched.
Travel can be reimbursed at an Enhanced rate if it is in accordance with FFP
requirements. Travel cannot be matched at a higher percent than the percentage
listed on the Personnel Detail Section for those staff traveling.
There is a Travel column on the Personnel Detail section in the budget template. To
accurately calculate the average Match %, an "X" must be selected from the drop
down for each staff member who will be traveling.
Requirements
Prior MCAH written approval is required for travel and training costs for staff not
listed on the Program Budget, but who contribute a portion of their time to the
MCAH program. Any written approval from CDPH/MCAH as well as any receipts
or information required for Travel Reimbursement must be retained by the
Agency for audit purposes.
Training
Training costs are listed on the budget for staff who conduct or attend conferences
and training that are directly related to the objectives described in the SOW.
• Agencies may host or sponsor Program-related trainings,
seminars, workshops, or conferences.
• Training cannot be matched at a higher percentage than what is listed on the
Personnel Detail Page for those staff for whom training is being budgeted.
Training can be reimbursed at an Enhanced rate if a SPMP is providing
training to another SPMP and it meets one of the FFP objectives.
Requirements
Prior written MCAH approval is required for the following:
• Training and associated travel and per diem costs for staff not listed on
the budget, but who contribute a portion of their time to the Program.
• To host trainings, seminars, workshops, or conferences.
July 2025 45 California Department of
*Public Health
PROCUREMENT AGREEMENT NUMBER: P-25-525
Fresno Interdenominational Refugee Ministries (FIRM)
October 21, 2025
Procedure
Agencies requesting approval to host trainings or seminars must submit the following
items:
• A description of the proposed training or seminar in the Program
Budget Justification Narrative
• A written request at least 60 days prior to the proposed training or
seminar date(s) to the Contract Liaison and Program Consultant
which includes:
o The date and location of proposed training or seminar
o Subject matter of the training or seminar
o Draft of agenda and list of instructors
o Draft of instructional/educational materials
o Targeted audience and projected number of attendees
o Draft of publicity materials
o Total cost
Note: Federal regulations disallow the use of any federal funds for advocacy at
the local, state, or federal level. Therefore, the $1,100 allocated for the semi-
annual MCAH Action training conference may only be used for training and travel
related expenses to assist in meeting the educational needs of the MCAH
Director. This should be shown in your budget under the travel and/or training
line items, as appropriate. Any expenses related in any way to advocacy must be
paid from local agency funds and are not eligible for Title XIX matching funds.
Operating Expenses Other Than Travel and Training
Operating expenses other than travel and training include, but are not limited to,
items or costs used to support staff such as:
• Rent (methodology required: FTEs x 200 sq. ft. x up to $3 per square foot x 12)
• Office Supplies
• Communications
• Duplication
• Utilities
• Postage
• Minor Equipment-Audio/Visual equipment or Telecommunication items
(including phone systems, teleconferencing equipment computers,
printers, and furniture) having a base unit cost of less than $10,000.
For lines 1 through 15, enter in each operating expense type and the corresponding
dollar amount. A justification for each expense must be entered on the (II-V)
Justifications Worksheet. The justification must be detailed enough to substantiate
the costs.
Operating Expenses, other than travel and training, can only be reimbursed at the
Non-Enhanced rate. The total percentage of the Non-Enhanced Combined
Federal/State and Combined Federal/Agency columns in each line item cannot
exceed the Percent of Personnel Match as indicated on the right side of column 15
July 2025 46 1 California Department of
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PROCUREMENT AGREEMENT NUMBER: P-25-525
Fresno Interdenominational Refugee Ministries (FIRM)
October 21, 2025
in the Operating Expenses Detail.
Operating Expenses that do not meet the FFP requirements must be claimed as
unmatched (see page 9). The formula in the cell under the non-enhanced column
will have to be deleted in order to claim the expense as unmatched.
(III) Capital Expenditures
These expenditures are defined as major equipment items with a base cost of
$10,000 or more and useful life expectancy of one or more years. MCAH must
approve all capital expenditures in writing prior to purchase. Capital Expenditure
items purchased using any amount of CDPH/MCAH funds become the property of
the State of California.
Expenses entered will automatically be spread based on the Percent of Personnel
Matched but may be adjusted as necessary by shifting costs between funding
sources.
On the (II—V) Justifications Worksheet, briefly describe the necessity and cost for each
expenditure.
(IV) Other Costs
The Other Costs Detail Section is comprised of two expense areas as listed under
the main expense category below:
• Subcontracts
• Other Charges (i.e., Client Support Materials, Educational materials, etc.)
The total dollar amounts entered in the Other Costs Detail Section will populate the
Budget Summary Page.
Subcontracts
A subcontract is a written agreement between the Agency and a subcontractor.
Subcontracts or consultant services can be used only for activities directly related to
meeting the goals and objectives of the primary SOW. Subcontractors of LHJs may
match at the Enhanced rate only if the subcontractor is performing Enhanced
activities and is a governmental agency. If a subcontractor is matching at either
the Enhanced or Non- Enhanced rate, they are subject to all guidelines as stated in
the FFP Section of this Policy and Procedure Manual.
The use of a subcontractor or consultant must be explained and justified on the (II-
V) Justifications Worksheet. Line-item titles and amounts entered in the Other Costs
Detail section will populate in the (II-V) Justification Worksheet. Briefly describe the
necessity, types of services and cost for each subcontract.
Note: For any subcontract $5,000 or more, the agency must provide a subcontract
package for review and approval as described in the Subcontractor Agreement
Transmittal form.
Subcontract Requirements are included in the Terms and Conditions section of this manual.
July 2025 47 California Department of
*Public Health
PROCUREMENT AGREEMENT NUMBER: P-25-525
Fresno Interdenominational Refugee Ministries (FIRM)
October 21, 2025
Other Charges
Other Charges include, but are not limited to, costs to support the program such as:
• Client support materials items used in support of desired
behaviors/goals or items that have been determined as necessary for risk
reduction after an assessment has been completed. Items such as
cabinet locks, plug covers, pack `n plays, cribs, car seats, breast pumps,
diapers, baby clothes, school readiness materials (e.g., picture books,
manipulative toys), bus passes or other transportation tokens and flash
drives can be included in the invoiced amount.
• Educational Materials
• Outreach Materials
• Services such as development costs of media campaign advertising
Line-item titles and amounts entered in the Other Costs Detail Section will populate
in the (II-V) Justification Worksheet. On the worksheet, provide a brief explanation
of the necessity and cost of each expenditure.
Indirect Cost
CDPH requires each Local Health Department (LHJ) to submit their proposed
Indirect Cost Rate (ICR) and identify the method used to apply it - either:
• Total personnel costs (wages + fringe benefits), or
• Total allowable direct costs (includes personnel, fringe, operating, capital
expenditures, and *other costs).
* When using the direct cost method, overhead may only claim overhead
charges on the first $50,000 of each subcontract.
Agencies must use the ICR percentage and method approved by CDPH, as
published at the start of each program's annual AFA announcement letter.
If an agency chooses to apply a lower rate than the approved ICR, they must
complete the MCAH ICR Certification Form, available on the current Fiscal Year
AFA website.
Note: CDPH MCAH may also require agencies to complete the ICR Certification
Form even when using the approved rate. This form helps substantiate the rate
being applied by confirming the agency's methodology for calculating indirect costs
and ensures consistent documentation for audit and compliance purposes.
• Indirect Cost Limits:
o Up to 25% of total personnel costs, or
o Up to 15% of total allowable direct costs (as defined above).
• AFLP CBO's grant agreements are limited to claiming up to 15 percent of
personnel costs (wages and fringe benefits). Unless an alternate Federal
approved ICR has been submitted to MCAH and approved for use.
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• Total Indirect Costs are distributed among the Agency's Unmatched and Non-
Enhanced budget columns based upon the Percent of Personnel Matched.
• Total Indirect Costs are not matched at an Enhanced rate.
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PROCUREMENT AGREEMENT NUMBER: P-25-525
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Budget Revisions
Overview
CDPH/MCAH allows changes to previously approved Program Budget Documents
to update and accurately reflect program need once per fiscal year. Budget
revision (BR) proposals will be accepted for consideration only if the following
criteria have been met:
• Your request must be submitted during the third quarter period, January-
March, of the current fiscal year.
• Your 2nd quarter invoice has been submitted and approved, and your BR must be
submitted no later than March 31 st.
• Agencies must first contact their assigned Contract Liaison of the intention to
do BR. Once CL approves the BR request, the agency can complete the BR
tab on the budget template and submit for review and approval.
MCAH Contract Liaisons and program consultants will review the request and if the
revision is approved, the Contract Liaison will inform the agency of approval. All
budget revisions will require CDPH/MCAH written approval prior to implementation.
Requirements for BR's
Upon approval, agencies allowed to proceed with a budget revision must submit
their proposed revision as follows:
• Submit the proposed budget revision via email to your Contract Liaison.
• Obtain formal written approval from CDPH/MCAH to proceed with signed BR.
• Sign approved budget template and submit to your CDPH/MCAH Contract
Liaison.
• Any invoice affected by the pending budget revision cannot be submitted to
CDPH/MCAH until the revised budget is approved.
The following documents are required for submission via email:
• Cover Letter stating reason the budget revision is necessary and
where changes are requested
• Revised Budget Template (including completed Justification tabs)
• Revised or additional duty statements, if applicable
• Revised organization charts, if applicable
• Any other documents/forms that are applicable, for example, updated
FFP/TXIX attestation form if new SPMP personnel are added to the
budget.
Once the revised budget documents are approved by CDPH/MCAH, the agency will
submit a signed copy of the budget documents to their MCAH Contract Liaison.
July 2025 50 California Department of
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PROCUREMENT AGREEMENT NUMBER: P-25-525
Fresno Interdenominational Refugee Ministries (FIRM)
October 21, 2025
Invoices and Payments
Invoices
CDPH/MCAH reimburses agencies for actual costs incurred in meeting the
objectives as specified in the SOW, not to exceed the approved program budget.
Quarterly and monthly invoices are due to CDPH 45 days after the end of the
invoiced period and 45 days after for final invoices. A preliminary review is not
required but can be helpful in identifying potential errors. Prior to submitting a
formal invoice, agencies may submit their invoice package directly to their Contract
Liaison for preliminary review. A preliminary review must be submitted no less than
two (2) weeks prior to the invoice deadline. Contact your Contract Liaison to
arrange the review.
Agencies ready to submit their invoices must utilize their approved and State MCAH
certified budget and invoice workbook. Each signed invoice and its supporting
documentation must be submitted in a separate email (one invoice per email) in
PDF and excel format to the dedicated MCAH invoice inbox:
MCAHlnvoices(a)_cdph.ca.gov.
Invoice Submission (How to Submit Your Invoice)
Your Contract Liaison and Program Consultant will review the invoice for correct
format, accuracy and availability of funds. Failure to use the appropriate naming
convention can result in delays in reimbursement. To ensure appropriate
processing, please use the following invoice naming protocol and in the subject line
of the email:
Agreement Number, Agency Name, Fiscal Year and Invoice Month and Number
(starting with Month 1 or Quarter 1 as applicable)
CBO Example:
AGREEMENT#20-10004, SAN DIEGO COUNTY, FY2020-21,
MONTHLY/QUARTERLY, INVOICE
LHJ Example:
AGREEMENT#201801, SACRAMENTO COUNTY, FY 2020-21, Q1 INVOICE
Invoice package includes the following:
• Signed Cover letter on official agency letterhead (PDF) — the date the
cover letter was prepared, program being invoiced, inclusive dates for
invoicing period, agreement number, invoice number, total amount of the
invoice, contact name, contact number, original signature, agency remittance
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October 21, 2025
address and an explanation on the cover letter regarding any variance from the
approved budget such as:
o Personnel changes or vacancies
o Substitutions of items budgeted under Other Costs
o Adjustments or corrections from a prior quarter
• Signed Invoice (PDF)— signed and dated by the agency's fiscal agent and Program
Director
• Excel Version of the invoice (invoicing of the approved
CDPH/MCAH invoice excel workbook)
• Signed & completed TXIX Cover Sheet (if applicable)
• Signed and checked Attestation form (only applicable if there are new staffing)
• Title V and/or Title XIX Time Studies (if applicable)- Time Study Data Report
for Summary of FFP (for all staff invoicing Title XIX Funds) and/or Title V Time
Study Report for the time study month of the invoice period (for all staff in the
MCAH budget invoicing Title V Funds)
For updated invoicing process, including a list of invoice deadlines please visit the
CDPH/MCAH website.
Your Contract Liaison and Program Consultant will review the invoice package for
the correct format, accuracy, and available funds. It may be returned due to
incompleteness or other discrepancies that cannot be processed by program staff.
FFP Requirements
Invoicing requirements for FFP are as follows:
1. Expenses requiring prior written approval will be reimbursed only if approval has
been granted.
2. Personnel costs invoiced must be based on either a time card or a time study
(for all personnel claiming FFP), rather than approved budget documents.
Budget documents are only an estimate of expenditures and invoices are
based on actual costs.
3. Invoices claiming FFP must be accompanied by an approved time study
report for each person claiming FFP. The time study report must reflect 100%
of employee's paid work time for a minimum of one full month per quarter,
and at a minimum contain the following information:
• Agency name
• Time study period
• Time study month
• First and last name of employee
• Employee classification or title
• SPMP — yes or no
• Time base —full time/part time
• Budget line number
• Percent of time studied to each program listed
• Percentage of time by activity classification
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• Enhanced — (75/25)
• Non-Enhanced — (50/50)
• Unmatched
• MCP for each program and/or staff listed
4. The time study summary report is contained in the CDPH/MCAH FFP
Calculation File which is available in the Forms Section of the AFA page on
the CDPH/MCAH website. Agencies must use the most current version of
the FFP Calculation File or a CDPH/MCAH approved alternate.
5. Negative balances (red) are not allowed on any funded total line.
6. When the budget is overspent in one column and underspent in another,
agencies have the option to move expenses from an Enhanced rate to a
Non-Enhanced rate (from 75/25 to 50/50), or from matched funds (Title
XIX) to unmatched funds (Title V, SGF, agency funds).
7. Information entered on the invoice will automatically update the Fund
Reconciliation Worksheet. This worksheet is used to monitor remaining
fund balances and should be reviewed before submitting invoices to
avoid payment reductions due to insufficient funds.
Special Considerations
MCAH provides two methods to recoup costs from previous quarters or months
when the fiscal year has not been closed.
1. Recoup on subsequent invoices for the same fiscal year when the
year is not closed out. Agencies should contact their MCAH CM for
assistance with this option.
2. The Supplemental Invoice.
Costs entered as changes or adjustments from a previous quarter must be listed and
described on a separate line item in the appropriate expense category. Please describe
the following:
• The type of cost or line item.
• Invoice period in which the cost was incurred.
• Percentages used to distribute the costs should be the same as those
used on the invoice originally submitted for the period in which the
expenditures occurred. Any changes or adjustments must be explained
on the invoice cover letter.
CBOs that submit monthly invoices have the choice to invoice using the most current
information data system downloaded MCP for each month, or to use the same MCP
for all three months of the quarter. At the beginning of each fiscal year CBO's that
invoice monthly must decide which method to use.
Note: Federal regulations disallow the use of any federal funds for advocacy at
the local, state, or federal level. Therefore, the $1,100 allocated for the semi-
annual MCAH Action training conference may only be used for training and
travel related expenses to assist in meeting the educational needs of the MCAH
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Director. This should be shown in your budget under the travel and/or training
line items, as appropriate. Any expenses related in any way to advocacy must
be paid from local agency funds and are not eligible for Title XIX matching funds.
Agencies are responsible for federal audit exceptions and must indemnify the State in
the event any exceptions are found, such as services that were:
• Invoiced for FFP but were not eligible for FFP
• Invoiced for FFP but for which there was no proper FFP match
• Invoiced for FFP but for which agency dollars were not expended, as
invoiced, when claiming FFP
• Invoiced for FFP but were not adequately documented
MCAH approval and payment of invoices is not evidence of allowable costs. Allowable
costs are determined by means of a State and/or Federal fiscal and program audit.
Supplemental Invoices
A Supplemental Invoice is to be used only when the agency determines additional
charges are necessary after all invoices have been submitted and processed by
CDPH/MCAH. Supplemental invoices must be pre-approved by the Contract Liaison
prior to submission, approved Supplemental Invoices are due September 30th
If a Supplemental Invoice is being submitted, it must meet all the requirements for a
standard invoice as noted above and must additionally:
• Be titled "Supplemental Invoice"
• Reflect only the amount of the supplemental billing
• Reflect the same percentage distribution as the invoice period in
which the actual cost was incurred
Invoice Detail Worksheet
Invoice Detail Worksheets are nearly identical to the Budget Worksheet in format
and operation and share many of the same policies and requirements. Therefore,
this Section will only note the unique differences of the Invoice Worksheets. Please
refer to the Budget Documents Section for more information regarding
Budget/Invoice policies, requirements and procedures.
Personnel Detail Section:
• For each staff member enter the actual fringe benefit amount for the
month or quarter in which you are invoicing.
• For each staff member enter the total wages for the time period being claimed
• If matching, enter the non-enhanced and enhanced percentages.
• Enter the percent time in program for each staff member that is
claiming FFP. This percentage can be found on the Time Study
Data Report for Summary of FFP.
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PROCUREMENT AGREEMENT NUMBER: P-25-525
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invoice DeadlineE
Invoice Deadlines for the following programs: MCAH, AFLP, BIH, All CHVP, and PEI.
Quarter Inclusive Dates Date Due to MCAH
Quarter 1 July-September November 15th
Quarter 2 October-December February 15th
Quarter 3 January-March May 15th
Quarter 4 April-June August 15th
*Approved Supplemental Invoices are due September 30tn
Payments
CDPH/MCAH is liable only for actual costs expended against the approved program
budget and SOW.
Maximum Amounts Payable
The maximum amount payable for any fiscal year cannot exceed the CDPH/MCAH
approved Agreement and Budget amounts for that fiscal year. The agency must
meet all the objectives as specified in the SOW and have incurred the actual costs to
receive the maximum amount payable under an approved Agreement and Budget.
Agencies are responsible for ensuring that all costs included in this proposal are
allowable in accordance with the requirements of Federal award(s) to which they
apply, including 45 CFR Part 75, Uniform Administrative Requirements, Cost
Principles and Audit Requirements for Health and Human Services Awards.
Reimbursement Limitations
CDPH/MCAH will not reimburse the agency for:
• Overtime at a rate greater than the employee's regular hourly salary
• Earned CTO
• Any services that the agency may claim for reimbursement under
any other State, Federal, agency, or other governmental entity
contract or grant, any private contract or agreement, or from the
Medi-Cal program
• Any services provided under this Agreement and Budget, which are
otherwise reimbursable by any third-party payer(s). The agency must fully
exhaust its ability to receive third-party reimbursement
• Any subcontract funds expended prior to CDPH/MCAH approval may
not be reimbursable in the event CDPH/MCAH should subsequently
disapprove the proposed subcontract
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October 21, 2025
If the agency receives any third-party reimbursement for services already
reimbursed by CDPH/MCAH, the agency must immediately remit that
amount to CDPH/MCAH or offset the amount against future invoices.
Recovery of Overpayments
CDPH/MCAH will recover overpayments to the agency including, but not
limited to, payments determined to be:
• In excess of allowable costs
• In excess of expenditures that can be supported by required time
study documentation (i.e., required FFP, Title XIX matching)
• In excess of the amounts usually charged by the agency or any of its
subcontractors
• For services not documented in records of the agency or any of its subcontractors
• For any services where the documentation of the agency or any of
its subcontractors only justifies a lower level of payment;
• Based upon false or incorrect invoices
• For services deemed to have been excessive, medically unnecessary or
inappropriate
• For services arranged for or rendered by persons who did not
meet the standards for participation in the program at the time
the services were arranged for or provided
• For services not covered in the program SOW
• For services that should have been billed to other programs, the Medi-
Cal program or any other entitlement program for which the client was
eligible to receive payment for such services
Procedures
CDPH/MCAH has three options available for the recovery of overpayments:
1. Agency may pay the full amount in one payment
2. Agency may arrange with CDPH Accounting Section to make payments (12
months maximum)
3. Agency may request that CDPH/MCAH deduct the amount of over
payment from a subsequent invoice(s). Repayment is to be made
as soon as possible but final payment shall not exceed 12 months
from the date of the discovery
Upon receipt of an audit `Action Notice,' CDPH Accounting will send an invoice to
the agency, establish accounts receivables, and work with the agency in
determining a recovery method. All recovery activities are coordinated directly
through CDPH Accounting.
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PROCUREMENT AGREEMENT NUMBER: P-25-525
Fresno Interdenominational Refugee Ministries (FIRM)
October 21, 2025
Payment Withholds
CDPH/MCAH, at its discretion, may withhold up to 100% of any amount billed for
services until the agency complies with the provisions of the Agreement.
CDPH/MCAH will notify the agency in writing regarding non-compliance
determinations.
This notification includes:
• The reason for each payment withhold determination
• The percentage withheld (if applicable), or the intent to withhold
• The effective date, conditions, and duration of the withhold
The agency will be afforded a reasonable opportunity to discuss with CDPH/MCAH and
respond to the notification. Upon agency compliance, CDPH/MCAH will release the
amount withheld for payment to the agency.
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PROCUREMENT AGREEMENT NUMBER: P-25-525
Fresno Interdenominational Refugee Ministries (FIRM)
October 21, 2025
Audits
Overview
All agencies receiving funding from CDPH/MCAH must comply with applicable
federal and state audit and reporting requirements. These include, but are not
limited to:
• 2 CFR Part 200 — Uniform Administrative Requirements, Cost Principles,
and Audit Requirements for Federal Awards
• Generally Accepted Government Auditing Standards (GAGAS, also known
as the Yellow Book)
• Reporting and Audit Requirements per Exhibit F — Federal Terms and
Conditions for Allocations and Cooperative Agreement (version
October 2014)
Federal and state officials may conduct audits, monitoring or on-site reviews of
agencies and their subcontractors during standard business hours. These reviews
are intended to assess compliance with program agreements.
CDPH/MCAH may also conduct technical assistance site visits.
On-Site Technical Assistance Reviews
CDPH/MCAH may initiate an on-site technical assistance review, either at its discretion
or at the agency's request. These informal assessments help identify potential
compliance issues and ensure alignment with program expectations ahead of formal
audits.
Review process:
• Entrance Meeting - Review scope, required documents, and workspace needs.
• On-Site Review - Examine administrative, programmatic, and fiscal practices.
• Exit Meeting - Share preliminary findings and allow time to respond.
• Agency Response Window— 2-4 weeks to submit supporting documentation.
• Summary Report - Document findings and recommendations.
• Corrective Action Plan (CAP) - Required if deficiencies are identified.
• CAP Monitoring - Follow-up on implementation of corrections.
• Fiscal Recovery Plan - Required for recovery of unallowable costs, if needed.
Corrective Action Plan (CAP)
If any review or audit identifies areas of noncompliance, the agency must submit a CAP
that:
• Address each finding
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• Describes corrective actions and responsible personnel
• Include timelines for completion
Failure to submit or follow the CAP may result in sanctions, such as funding reductions,
cost disallowance, or termination of the agreement.
Audit Requirements
Agencies that expend $1,000,000 or more during the agency's fiscal year in Federal
awards must undergo a Single Audit or Program Specific Audit in accordance with 2
CFR 200.501 .
Audit reports must be submitted to the Federal Audit Clearinghouse (FAC):
• within 30 calendar days after the agency receives the auditor's report, or
• within 9 months after the end of the audit period (whichever comes first).
Remedies for audit noncompliance
In cases of continued inability or unwillingness to have an audit conducted in
accordance with this part, the following actions may be taken under 20 0.339:
a) Temporarily withhold payments until the recipient or subrecipient takes corrective
action.
b) Disallow costs for all or part of the activity associated with the noncompliance of the
recipient or subrecipient.
c) Suspend or terminate the Federal award in part or in its entirety.
d) Initiate suspension or debarment proceedings as authorized in 2 CFR part 180 and
the Federal agency's regulations, or for pass-through entities, recommend
suspension or debarment proceedings be initiated by the Federal agency.
e) Withhold further Federal funds (new awards or continuation funding) for the project
or program.
f) Pursue other legally available remedies.
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Terms and Conditions
General Terms and Conditions
All MCAH program agreements and budgets are subject to limitations set by federal or
state law, legislature or court decisions. These agreements must comply with:
• 2 CFR Part 200 - Uniform Administrative Requirements, Cost Principles, and
Audit Requirements for Federal Awards
• State Contracting Manual
• General Terms and Conditions for non-IT services contracts except for
Interagency Agreements (Effective 4/4/2017)
CDPH/MCAH may revise or void agreements and budget within 30 days' written notice
in the event of funding reductions or legal changes. If an agreement is rendered invalid,
CDPH/MCAH will have no financial or contractual obligations, and the agency will be
released from its obligations as well.
Agencies receive funding from CDPH/MCAH, as the pass-through entity, to provide
MCAH-related services must deliver the full scope of services described in the Scope of
Work (SOW), regardless of the proportion of funding provided by CDPH/MCAH.
Special Terms and Conditions
All MCAH agreements must also comply with:
• Exhibit D — CDPH Special Terms and Conditions for Cooperative Agreement in
accordance to HSC 38070 (August 2022).
• Exhibit F — Federal Terms and Conditions for Allocations and Cooperative
Agreement (October 2014).
• Information Privacy and Security Requirements— IPSR Exhibit used for all
agreements (September 2022).
Additional MCAH Provisions
Subcontract Requirements
(Applicable when subcontractors or consultants are engaged)
a. Prior Authorization: Required for any subcontract $5,000 and over.
b. Competitive Bidding: Minimum three bids or documented justification.
c. CDPH/MCAH Approval: CDPH reserves the right to approve or reject the
subcontractors.
(1) Costs incurred before approval may not be reimbursed.
(2) Subcontract replacement must be completed within 30 days if required.
d. Documentation: Maintain agreements and procurement records for
CDPH/MCAH.
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e. Payment and Oversight: Prime agencies are responsible for payment and
performance.
f. Compliance Pass-through: The subcontract agreement must include a
clause:
"(Subcontractor Name) agrees to maintain and preserve all records related to this
agreement for seven (7) years following the termination of(Agreement Number) and
final payment from CDPH to the contractor. During this period, (Subcontractor Name)
shall grant CDPH or any authorized representative, access to review, audit, or examine
any pertinent books, documents, papers and records. (Subcontractor Name) also
agrees to make relevant personnel available for interviews regarding such records upon
request."
Audit and Record Retention
Under 2 CFR 200.337, federal and state officials must be granted access to any records
relevant to the award.
Per the State Contracting Manual, Section 7.50, subsection B — Records Keeping and
Retention, agencies and/or subcontractors must retain and provide the following
documentation for seven (7) years upon request:
1. Policy and Procedures, including updates
2. Notices of Intent to Award
3. Approved Agreement Funding Application
4. Initial fiscal year budget and all subsequent revisions
5. SOW, duty statements, organization charts, position classifications.
6. Copies of all changes that occur to any of the documents above during the year,
including CDPH/MCAH approvals of those changes.
7. Employee timesheets/timecards
8. FFP time studies documentation
9. Indirect Cost documentation
10.Invoices and expense supporting documentation
11.Cost allocation files
12.Supplemental invoice (if applicable).
Filing Format: Audit files can be kept in electronic or paper format.
Further audit requirements are detailed in Exhibit F.
Capital Expenditures and Inventory Controlled Items
In accordance with 2 CFR 200.1 Capital Expenditures means expenditures to acquire
capital assets or expenditures to make additions, improvements, modifications,
replacements, rearrangements, reinstallations, renovations, or alterations to capital
assets that materially increase their value or useful life.
Agencies must obtain prior written approval before purchasing capital assets and
inventory-controlled items. Requirements include:
• Demonstrated program necessity
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• Maintenance of inventory records (CDPH 1204)
• Submission of vendor receipts upon request
• Allowance for audit and verification
Failure to obtain prior approval may result in cost disallowance.
Equipment and other capital expenditures are unallowable as indirect costs (See more
rules of allowability with 2 CFR 200.439).
Equipment Disposition
In line with 2 CFR 200.313 (e) Equipment Disposition — When equipment acquired
under a Federal award is no longer needed for the original project, program, or for other
activities currently or previously supported by a Federal agency, the recipient or
subrecipient must request disposition instructions from the Federal agency or pass-
through entity if required by the terms and conditions of the Federal award.
Agencies shall follow CDPH/MCAH's disposition instructions as follows:
1. Notify the Contract Liaison (CL) of disposal intentions.
2. The CL will obtain the approval from the Program Support Division (PSD) Asset
Manager.
3. Follow specific procedures depending on item value and sensitivity.
* Use forms CDPH 1204, STD 152, and CDPH 9051 (for data-wiping sensitive IT)
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Glossary of Terms and Acronyms
Term Definition
Actual Cost The actual price paid for real bona fide purchase costs of goods and services
pursuant to the conduct of the MCAH Agreement and Budget.
AFA Agreement Funding Application (AFA). The agreement between CDPH/MCAH
and the Agencies to administer the MCAH programs. This includes, but is not
limited to, the SOWs, Budget Documents, and Policies and Procedures.
AFLP Adolescent Family Life Program (AFLP).
Agency A Local Health Jurisdiction (LHJ); i.e., city or county health department or
Community Based Organization, responsible for the public health needs in
that designated geographic area. In California there are 61 Local Health
Jurisdictions, 58 county public health departments and 3 city public health
departments (Berkeley, Long Beach & Pasadena).
Agency Funds Agency contributions towards the budget to help fund the activities needed to
fulfill the program SOW.
Allowable Cost Costs incurred which are necessary to meet the provisions of the SOW and
are approved in the MCAH Agreement and Budget.
Base Cost Per Unit The purchase price of an item, excluding tax, delivery, installation charged, etc.
Budget Revision A revision in the previously approved budget to change line items and/or
amounts.
Capital Expenditures Major Equipment with a base cost per unit of$10,000 or more and a useful life
expectancy of one or more years, including Telecommunications, and
Electronic Data Processing/ Automated Data Processing software
CBO A Community Based Organization (CBO), a non-profit organization which
works to serve the disadvantaged in the community in which it is located.
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Term Definition
CDPH California Department of Public Health (CDPH) works to protect the public's
health and shape positive outcomes for individuals, families, and communities.
CDPH 1203 Contractor's Equipment Purchased with CDPH Funds is a form to track
Contractor equipment and miscellaneous property which is purchased with
CDPH funds and is used to conduct state business under the contract.
CDPH 1204 Inventory/Disposition of CDPH Funded Equipment form for inventory and
disposition of equipment purchased with CDPH funds.
CMS Centers for Medicaid and Medicare Services (CMS).
Confidential Any information containing patient identifier, including but not limited to:
Information Names
Address
Telephone number
Social Security number
Medical identification number
Driver license number
Contract Liaison A CDPH/MCAH staff assigned to an agency, who provides consultation
(CL) concerning fiscal direction and issues such as Budget development and
Invoicing.
Corrective Action If an audit reveals that an Agency is not following required procedures or
Plan (CAP) maintenance of documents, CDPH/MCAH will instruct the Agency to
develop a Corrective Action Plan (CAP).
The CAP will define the corrective actions the Agency must implement to
become compliant. The CAP must be reviewed and approved by
CDPH/MCAH staff.
CPSP Comprehensive Perinatal Services Program (CPSP) is an obstetrical,
psychosocial, nutritional, and health education services and related case
coordination provided by or under the personal supervision of an approved
CPSP provider during pregnancy and 60 calendar days following delivery.
CTO Compensatory Time Off (CTO), time off in lieu of overtime pay.
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Term Definition
DHCS Department of Health Care Services (DHCS) is the state agency
responsible for managing and administering California's Medicaid
program, known as Medi-Cal.
Duty Statement Defined activities specific to program and position requirements and are
considered legal and contractual obligations which can be audited.
Enhanced Rate Federal Title XIX reimbursement of eligible approved costs at the ratio of
75% federal dollars to 25% State or Agency general fund dollars.
FFP Federal Financial Participation (FFP) program is a funding mechanism
used to generate additional revenue by reimbursing Agency or State
funds with Title XIX dollars at an Enhanced and/or Non-enhanced rate
for the proper and efficient administration of the Medi-Cal program's two
objectives.
Fringe Benefits Employer contributions for employer portion of payroll taxes (i.e., FICA,
SUI, SDI, Training), Employee health plans (i.e., health, dental, and
vision), Unemployment Insurance, Workers Compensation Insurance,
and Employer's portion of pension. Retirement plans are included,
provided they are granted in accordance with established written
organization policies and meet all legal and Internal Revenue Service
requirements.
FTE Full-Time-Equivalent (FTE) means a standard eight-hour workday; 40
hours per week; or 2,080 hours per year.
Goals Goals are overall statements of the mission and purpose of the program
or an individual program component.
July 2025 65 California Department of
Public Health
PROCUREMENT AGREEMENT NUMBER: P-25-525
Fresno Interdenominational Refugee Ministries (FIRM)
October 21, 2025
Term Definition
Good Cause Circumstances which are beyond the control of the agency and includes,
but is not limited to:
Damage to or destruction of the Agency's business office and/or records
by a natural disaster, including fire, flood, or earthquake or when
circumstances involving such disaster have substantially delayed
Agency's operations.
Theft, sabotage, or other deliberate, willful acts by an employee that
have been reported to the appropriate law enforcement or fire agency
when applicable.
Other circumstances that are clearly beyond the control of the Agency
that have been reported to the appropriate law enforcement or fire
agency when applicable.
Failure by CDPH/MCAH to fully execute the MCAH Agreement and
Budget later than six months after the MCAH Agreement and Budget
start date.
Untimely illness or absence of any employee trained to prepare
invoices, reports, or Budget Revisions. This does not include an
Agency vacancy. All circumstances will be reviewed and
approved/disapproved on a case-by-case basis by CDPH/MCAH
management.
Failure by CDPH/MCAH to fully execute revisions before the MCAH
Agreement and Budget's termination, expiration date, or fiscal year
end.
Indirect Costs Those costs which are within the Agency and cannot be clearly identified
as expenses to direct program costs. The calculation is based on Total
Wages (excluding benefits) from the Personnel Detail Worksheet.
Job Specification County civil service classification describing standard educational and
experience requirements for appointment to specific positions. Job
Specification can be referred to as a classification specification
LHJ A Local Health Jurisdiction (LHJ), i.e., city or county health department,
responsible for the public health needs in that designated geographic area
MAA Medi-Cal Administrative Activities (MAA).
July 2025 66 * California Department of
*Public Health
PROCUREMENT AGREEMENT NUMBER: P-25-525
Fresno Interdenominational Refugee Ministries (FIRM)
October 21, 2025
Term Definition
Major Equipment A tangible or intangible item having a base unit cost of$10,000 or more with
a life expectancy of one (1) year or more and is either furnished by CDPH
or the cost is reimbursed through this Agreement. Software and videos are
examples of intangible items that meet this definition.
MCAH Maternal, Child and Adolescent Health (MCAH).
MCAH Director The Maternal, Child and Adolescent Health (MCAH) Director is an individual
appointed by the Agency who is responsible for carrying out the terms and
conditions of the MCAH program Agreement and Budget.
MCAH-Related Programs operated under CDPH/MCAH and accountable to follow the
Programs policies set forth in this manual; MCAH, AFLP, FIMR, SIDS, BIH and
CHVP.
MCP The Medi-Cal Percentage (MCP) is a percentage that identifies the portion
of the region's general population receiving MCAH-related services that are
Medi- Cal beneficiaries.
The MCP is one of two components that determine Title XIX claiming
amounts.
Medi-Cal California's Medicaid program that provides healthcare and service to those
who meet Medi-Cal eligibility requirements.
Medi-Cal Eligible Individuals who have applied for and been granted Medi-Cal benefits, as well
as the Medi-Cal potential eligible population (i.e., the population at the
poverty rate qualified to receive Medi-Cal benefits).
Minor Equipment A tangible item having a base unit cost of less than $10,000 with a life
expectancy of one (1) year or more and is either furnished by CDPH or the
cost is reimbursed through this Agreement.
Non-Enhanced Federal Title XIX reimbursement of eligible approved costs at the ratio of
Funding 50% federal dollars to 50% State or Agency general fund dollars.
Organization Chart A diagram illustrating the interrelationship of the local health jurisdiction staff
associated with all MCAH-funded programs.
July 2025 67 California Department of
*Public Health
PROCUREMENT AGREEMENT NUMBER: P-25-525
Fresno Interdenominational Refugee Ministries (FIRM)
October 21, 2025
Outreach Activities to inform and/or connect persons to available services or care.
Term Definition
Program Consultant A CDPH/MCAH staff person, assigned to an agency or program, that
(PC) provides skilled expertise in the areas of program standards, SOW,
personnel, program policy development, and quality improvement.
PSC Perinatal Services Coordinator (PSC) is the person, in collaboration with the
MCAH Director, responsible for the implementation of the CPSP in the LHJ.
QA Quality Assurance (QA). A program for the systematic monitoring,
evaluation, and improvement of the various aspects of a program, entity or
group.
Salary Savings Salary savings are a result of unfilled positions and reduced FTEs and are
not allowable in AFLP without Contract Liaison Approval. The criteria is that
services provided should not be diminished to cover operational expenses.
Please consult the MCAH Program Consultant or Contract Liaison.
Supporting Supporting documentation gives support to the claiming of matchable FFP
Documentation funding, can be requested by CDPH/MCAH to verify high percentages of
FFP matching, and is reviewed during on-site audits to verify the percentage
of
FFP matching.
SGF State General Fund (SGF).
SIDS Sudden Infant Death Syndrome (SIDS).
SOW A Scope of Work (SOW) is a component in the MCAH Agreement and
Budget which contains the goals, objectives and methods of evaluation to
be met under the terms and conditions of this MCAH Agreement and
Budget.
SPMP Skilled Professional Medical Personnel (SPMP) have the education and
training at a professional level in the field of medical care or of an
appropriate medical practice.
July 2025 68 California Department of
Public Health
PROCUREMENT AGREEMENT NUMBER: P-25-525
Fresno Interdenominational Refugee Ministries (FIRM)
October 21, 2025
Subcontract A written agreement between the Agency and a subcontractor specifically
related to securing or fulfilling the Agency's obligation to CDPH/MCAH
under the terms of the MCAH Agreement and Budget.
TCM Targeted Case Management (TCM), a Medicaid program.
Time Study A method to record time spent on all activities for those staff claiming FFP.
July 2025 69 California Department of
Public Health
PROCUREMENT AGREEMENT NUMBER: P-25-525
Fresno Interdenominational Refugee Ministries (FIRM)
October 21, 2025
Term Definition
Title V Funds Unmatchable federal MCAH Block Grant funds authorized under Title V of
the federal Social Security Act.
Title XIX Funds Federal Medicaid money obtained under Title XIX of the federal code by
means of State and/or local revenue match for costs of activities related to
eligible and potentially eligible Medi-Cal women and children.
July 2025 69 California Department of
Public Health
P-25-525 Agreement PDF
Final Audit Report 2025-11-12
Created: 2025-11-04
By: Christine Barker(christine@firminc.org)
Status: Signed
Transaction ID: CBJCHBCAABAAVdWaktlNv5-haD84ajni54jA_bswvC2j
"P-25-525 Agreement PDF" History
Document created by Christine Barker(christine@firminc.org)
2025-11-04-9:56:18 PM GMT
Document emailed to Thoua Lee (thoua.lee1979@gmail.com)for signature
2025-11-04-10:02:21 PM GMT
Christine Barker(christine@firminc.org) replaced signer Thoua Lee (thoua.lee1979@gmail.com) with Thoua Lee
(thoualee@hmongtvnetwork.com)
2025-11-12-4:32:28 PM GMT
Document emailed to Thoua Lee (thoualee@hmongtvnetwork.com)for signature
2025-11-12-4:32:28 PM GMT
Email viewed by Thoua Lee (thoualee@hmongtvnetwork.com)
2025-11-12-7:27:10 PM GMT
Document e-signed by Thoua Lee (thoualee@hmongtvnetwork.com)
Signature Date:2025-11-12-9:42:30 PM GMT-Time Source:server
Document emailed to Matias Bernal, PhD (mattdromundo@gmail.com) for signature
2025-11-12-9:42:32 PM GMT
Email viewed by Matias Bernal, PhD (mattdromundo@gmail.com)
2025-11-12-9:43:53 PM GMT
Document e-signed by Matias Bernal, PhD (mattdromundo@gmail.com)
Signature Date:2025-11-12-9:45:47 PM GMT-Time Source:server
Agreement completed.
2025-11-12-9:45:47 PM GMT
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