July 29, 2019 — Last week, the Board of Supervisors voted 4-1, with Supervisor Ted Williams dissenting, to approve an $18,976,733 contract for Redwood Quality Management Company (RQMC), the contractor that provides specialty mental health care to Medi-Cal beneficiaries and the indigent on behalf of the county.
RQMC started contracting with the county to provide mental healthcare to children in 2013. In July of 2016, the company took over adult mental healthcare from Ortner Management Group, a contractor based in Yuba City.
Dr. Jenine Miller, who heads up the county’s behavioral health department, told the board that there are a few changes in this year’s contract. RQMC used to have three contracts, one each for youth and adults, and a third for medication management. Now the single contract is divided into three areas that align with the state and federal funding streams. Miller said this makes it easier to avoid duplication and to make sure the county gets reimbursements from the federal government. About $9 million of the county’s mental health money is federally sourced, but only on a reimbursement basis. Another $3.5 million is from the Mental Health Services Act (MHSA), also known as the millionaire’s tax. RQMC uses that money to subcontract with about 14 other providers, including Manzanita, MCAVHN, Consolidated Tribal Health and Nuestra Alianza. Some additional MHSA programs are overseen by the county.
The third source is the public safety realignment initiative, a result of a 2011 order by the US Supreme Court to the State of California to reduce its prison population. This money flows to the county from the State Department of Healthcare Services. It’s used for indigent services and misdemeanor competency restoration, to treat mentally ill inmates who have been charged with misdemeanors so they can stand trial.
Camille Schraeder, who heads up RQMC and Redwood COmmunity Services, a non profit organization that subcontracts for some of the MHSA services, gave the board a quick outline of the number of outpatient clients who have been served this fiscal year. She also took the oppoturnity to put in a favorable word for the Affordable Care Act.
By far the greatest number of outpatient services is for people under 25 in Ukiah, at 41,260. The number of services for people over 25 in Ukiah came in second, at 21,690. The North Coast came in at 10,857 for all age groups. Willits came in a distant third, at just under 5,000 for all ages.
Crisis treatments come under their own category. Schraeder said RQMC makes about six crisis assessments per day, for a total of 2,295. Close to 30% (29.8%)of those assessments result in hospitalization. There is a total of 125 dedicated mental health beds throughout the county.
WIlliams said that, though he found the presentation thorough, he couldn’t approve the contract, becuase of its “monolithic” nature. The county, he fears, is forced to do either do nothing, or accept the contract from RQMC. While he supports the company, he declared himself unwilling to approve the giant contract.
Supervisor John McCowen asked if the nature of the contract would make it difficult for the county to issue a request for proposals from other providers for any one of the services now covered by RQMC and its subcontrators; or “the whole ball of wax.” Tammy Moss Chandler, director of the county’s Health and Human Services Agency, said the new structure, based on funding streams, actually makes it easier for her department to track.And Schraeder said efforts are underway to make sure that if another provider were to be selected, the transition would be much smoother than the one from Ortner to RQMC.