Sonoma County health program for the homeless under state scrutiny for low enrollment

A Sonoma County program aimed at providing wraparound health services to chronically homeless people is under scrutiny by the state after failing to meet enrollment requirements.

The county’s behavioral health division was among 25 agencies selected two years ago to take part in the Whole Person Care pilot program, a federally funded initiative focused on helping the most vulnerable. As part of the program, the county was awarded $16 million over five years.

In October, though, the county was put under a “corrective action plan” by the state for not enrolling enough homeless people in the program, despite the county reporting roughly 3,000 homeless people living in the area. If the state determines the county is still falling short of its goals come June, it could be hit with more state intervention measures or lose all of its funding through a contract termination.

The county’s behavioral health division is one of two agencies on the state’s improvement plan.

Bill Carter, who heads the division, remained optimistic the county will meet its enrollment and community outreach goals.

“Our approach after receiving the (corrective action plan) was to speak to our community providers and people involved on the project, and we all agreed that we need to do work on the ground,” Carter said, who took over the behavioral health team in November after working as the mental health director in Napa County.

The goal of the pilot program is to provide under the management of one entity, such as the county, whole person care - medical, behavioral health and social services - to homeless or at-risk individuals with serious mental illnesses, substance abuse and chronic diseases. By making health care more efficient and accessible, state officials hope it will improve individuals’ health outcomes.

At the local level, the Whole Person Care program was slated to serve ?3,040 people over five years and the county projected it would be able to provide services to an estimated 1,520 people by the end of December, according to documents.

However, the California Health and Human Services Agency in an October letter reported the county had served only ?231 people nearly a year after receiving the grant.

Additionally, the state department found in its evaluation that as of last year few resources were going toward service programs, and instead going to high administrative costs.

Of the $4.1 million allocated for the program last year, $450,000 went to direct services for the homeless, while more than $3 million went to administrative costs, according to an October letter from the state.

As part of the improvement plan, the county has regularly met with representatives from the state’s Department of Health Care Services to set incremental goals designed to increase the number of homeless people enrolled in the program to avoid penalties.

Jenny Symons, who manages the pilot program for Sonoma County, said the county faced an uphill battle to adequately launch the program after budgeting challenges following the October 2017 fires. Both of those circumstances severely limited the department’s success from the start, she said.

She said the county is following the state’s plan and working on boosting enrollment.

“We are at where we need to be. We gave them (state officials) enrollment numbers, and we are currently at 847,” Symons said. “So far we are following the plan closely.”

Two dozen community partners are working with the county to provide services to the homeless. They include West County Health Centers, Sonoma Valley Health Center and The Palms Inn, a former motel that now provides housing for homeless veterans and those chronically homeless.

Although most of the partners said they support the pilot program, some expressed concerns. A handful of community partner representatives said the county did not start actively involving them in the program until January, more than a year after receiving the grant.

“The process of getting our contracts in place, the county working with the state and the overall grant process took longer than anyone expected,” said Jed Heibel, director of community programs at West County Health Centers. “But as of last week we are starting to actually see the work roll out now.”

Not having a streamlined communication system has been another point of concern. Some partners also complained they’ve struggled to recruit patients and outreach workers.

Josefa Molina, director of behavioral health at Alliance Medical Center, said she still hasn’t been able to fill the outreach position in her department, meaning no one has been assigned to specifically work on the Whole Person Care program at her center for nearly a year.

“Getting the right match for the program and finding someone who understands issues of homelessness and knows how to engage people who are homeless is really important,” said Molina, who has referred a total of four people to the program.

Since her agency doesn’t have an outreach worker for the program, Molina said she refers patients from her own medical center to the program.

“The program is an excellent idea ... Having a program that can help people get to appointments and manage psychiatric illnesses is really important,” she said. “We just haven’t had people applying to the position.”

Symons said the county is meeting with state officials at the beginning of next month to discuss steps toward lifting the corrective action plan.

“This is a program that everybody is really dedicated to and is working really hard,” she said. “They (state officials) want us to succeed, which is awesome.”