HHS committee funds Montgomery Cares rate increase, advances shelter and infrastructure funding; clinic addition deferred

HHS committee members on the Montgomery County Council on April 21 approved several of the County Executive's recommended FY26 changes to the Department of Health and Human Services (DHHS) budget and capital improvement program while deferring a proposed new clinic addition for further review.

The committee voted to fully fund the County Executive's proposed increase to the Montgomery Cares primary care reimbursement rate, approve funds for the county's domestic violence services and to annualize infrastructure and other DHHS positions. Committee members also approved CIP amendments to advance funding for the diversion center project and accepted an FY25 supplemental appropriation related to the diversion center stabilization unit expansion. A separate proposal to add a new clinic to the Montgomery Cares network was deferred for additional information and discussion at the HHS work session scheduled April 28.

Why it matters: Montgomery Cares is the county's safety-net primary care network for uninsured and underinsured residents; changes to the per-encounter reimbursement rate directly affect clinic finances, staffing and capacity. The diversion center capital changes and domestic violence shelter funding address immediate facility and shelter needs countywide and have implications for service continuity and state grant compliance.

The committee approved funding to raise the Montgomery Cares reimbursement rate consistent with the County Executive's recommendation, an item staff said represents $963,361 in FY26 funding and would raise the total per-encounter reimbursement to about $113.50 (direct payment to clinics ~$111.35 after an administrative fee). The packet noted advocates are seeking a larger increase (to $175 per encounter); county staff recommended considering the increase in tranches to spread cost. After discussion the committee voted 2'to'1 to accept the executive's full recommendation; staff will not place the item on the reconciliation list.

Committee members also moved to defer action on adding a new clinic proposed by the Islamic Health Center of Maryland (ICM). DHHS staff and the Primary Care Coalition had provided a projected service model: the new clinic was estimated to serve 267 patients in the first partial year with about 720 encounters (2.7 visits per patient used in the projection). Council staff and the department agreed to provide a fuller explanation of the clinic's projected patient visits, how the clinic would join the Montgomery Cares network and how adding a clinic would affect existing provider capacity; that discussion is scheduled for the April 28 HHS session.

On staffing and revenue items, the committee concurred with previously approved and recommended changes: - A one'time salary equity adjustment of $994,034 for 127 DHHS positions (social workers and therapists) was noted as the FY26 impact of a memorandum of agreement with a union; the adjustment will be annualized in FY27 budgeting. - The county executive's recommendation to annualize 11 infrastructure FTEs (previously added by a FY25 supplemental; supplemental was approved 01/21/2025) was supported. The packet cites an expected $1,000,000+ in additional Medicaid-derived revenue tied to those positions and the executive recommended $1,300,000 to continue the 11 FTEs in FY26.

Domestic violence and related trauma services were a focus. The committee approved two items tied to the county's status as a state-recognized comprehensive domestic violence service provider: - $107,500 to bring the abuser intervention program in-house (transitioning an externally operated, revenue-generating abuser intervention program into DHHS operations). - $425,000 increase for the county's domestic violence shelter contract. DHHS reported the earlier FY25 approved shelter amount did not meet the actual cost to operate the shelter at the acuity and utilization levels seen; in prior procurement cycles no bidders responded at the FY25 amount. DHHS warned that if the county does not fund the higher amount a vendor may not be secured and shelter operations could be reduced or discontinued, which would risk losing the state's comprehensive domestic violence provider certification and associated grant eligibility.

The committee also approved annualization of two crisis therapists co-located at the Takoma Park Police Department ($249,194 offset by City of Takoma Park reimbursement per memorandum of agreement) to continue the diversion-of-police response model; one position was filled and recruitment for the second was underway.

Capital amendments: the committee reviewed and approved FY25'FY30 CIP amendments for the diversion center project. The packet documented a FY25 supplemental request that advances $650,000 in planned FY27 funds into FY26 (split $338,000 in GEO bond match and $312,000 state aid) to meet a state match and to support a stabilization unit scope expansion. An April amendment added $500,000 of new state aid targeted to the stabilization unit renovations; the overall project total did not increase but the schedule and funding timing changed to permit the stabilization unit and walk-in/youth-serving components to proceed this calendar year.

What the committee did not finalize: staff recommended, and the committee accepted, that certain smaller grants and one-time funds not be carried forward in the general fund (for example, an ARPA substance use services grant and a one-time 988 grant allotment), reflecting their one-time nature; these were listed as reductions in the packet. The committee also identified several contract reductions it will communicate to vendors with formal contract-monitor notices so partners have time to prepare.

Ending note: Council staff said the HHS Committee will carry remaining items to additional sessions later in the week; the full council will consider reconciliation items and the FY26 operating budget in subsequent hearings. The committee asked DHHS to provide follow-up materials on clinic-selection methodology, projected encounter math, and the state regulation reference for new stabilization unit requirements (Code of Maryland Regulations update referenced in the packet).