Board approves $3.57 million inmate medical contract; reimbursement range uncertain

The San Benito County Board of Supervisors approved a contract May 6 with Medeco (a jail medical services vendor) for inmate medical services at the county jail and youth services center. The contract formalizes the vendor recommendation the board previously received and carries a first-year cost of $3,566,000 for a term through June 30, 2029 with a 3% annual COLA and potential extensions.

Sheriff's office representatives told the board the county expects uncertain reimbursement through CalAIM (the state Medi-Cal initiative) and related billing pathways. "We have a range of possible reimbursement from a hundred thousand dollars a year to $1,400,000 a year," the sheriff said, describing differing methodologies behind estimates. He said Medeco had used the countywide Medicaid enrollment rate (30%) and transposed it to the incarcerated population, producing a low-end estimate of about $100,000 per year. By contrast, the county cited a California Department of Corrections and Rehabilitation (CDCR) analysis that suggested a much higher share — 80% to 90% — of incarcerated people could be eligible for CalAIM-billable services.

Using the CDCR-based assumptions and an estimated reimbursable rate of about $1,200 to $1,300 per incarcerated person, the sheriff's office presented a potential annual reimbursement range of about $1.15 million to $1.54 million. The sheriff cautioned that the methodology is unsettled and the county does not yet have a definitive reimbursement figure.

County staff said the current fiscal year and next fiscal year costs are covered from previously granted state CalAIM funding and that they do not currently expect a general-fund impact for those years. The county also clarified that youth detained at the county's youth services center are treated differently: the county's youth services intake data show roughly 80 youth intakes last calendar year, and youth services are 100% billable to Medi-Cal regardless of private insurance, meaning the county expects those youth services to be fully reimbursable.

After hearing no public comment on the item, the board approved the contract by roll-call vote. Supervisors recorded unanimous support on the motion to formalize the vendor contract.

The board asked staff to continue pursuit of accurate reimbursement methodologies and to return with further details as estimates firm up. The county will rely on the vendor, the sheriff's office, and state guidance to refine billable service estimates going forward.