Tulare County adopts broad Health & Human Services fee changes, raises clinic rates to 200% of Medicare

Tulare County supervisors voted unanimously on April 8 to adopt a set of fee changes proposed by the county Health & Human Services Agency (HHSA), approving 392 adjustments that agency staff said are needed to better match program costs.

The changes affect public guardian representative-payee services, the county-operated health care centers, immunization services and environmental health permitting and inspections. Rob Stewart, HHSA fiscal operations director, told the board the package includes 69 new fees, 249 increases, 60 decreases, 5 deletes and 9 description updates.

Why it matters: county staff said the last comprehensive update to the clinic fee methodology was in 2012 and that many fees have not kept pace with the actual cost of providing services. The board approved the package and authorized HHSA to implement the fees effective July 1, 2025.

“What you’ll see today is a sample,” Rob Stewart said during the hearing. “All of the proposals that you’ll see today, we have submitted and had our methodologies and proposals reviewed by the county auditor controller’s office, county counsel, and the CEO’s office, and obtained approval to proceed to the hearing today.”

Key changes and examples: - Health care centers: Staff proposed increasing the county’s prevailing clinic rates from 150% of the Medicare fee schedule to 200% of Medicare. For services not on the Medicare schedule, the county’s Medi‑Cal-based charge would rise from 100% to 200% of published Medi‑Cal rates. Stewart said the increase stays “at the low end” of comparable regional providers based on an informal survey. - Public guardian (representative payee): The monthly payee administrative fee would rise from $54 to $55 to reflect a Social Security Administration change. - Environmental Health: HHSA proposed a new annual application fee of $68 to replace several highly specialized plan‑review fees, a missed‑inspection charge for re‑scheduling inspections, and other permit adjustments. Two larger environmental fee increases highlighted in the presentation: the small‑quantity hazardous‑waste generator annual fee would increase from $266 to $346 (affecting about 680 facilities), and above‑ground tank facility permits would increase from $133 to $200 (about 150 facilities). Stewart said the environmental increases were generally capped near 15% except for a few categories where staff proposed higher adjustments to bring cost recovery closer to actual expense.

Board discussion focused on transparency and the potential impact on residents and businesses. “You mentioned a few times, Rob, specifically, the number of facilities, the number of individuals that would be impacted… It’d be nice to see those numbers on the slides,” Supervisor Larry McCarty said. Supervisor Amy Shuckling asked staff to create an FAQ and confirmed that HHSA conducts outreach to trade organizations and impacted businesses; HHSA staff said they would post an FAQ and continue outreach.

The board then closed the hearing and approved the package by a 5–0 vote. HHSA may implement the new fees beginning July 1, 2025, and Stewart said the full fee schedules and methodologies are included in the meeting agenda packet attachment labeled “summary proposed fees.”

What remains: Stewart said HHSA’s methodology and many individual fee lines are in the agenda materials and that the department will publish details and continue outreach to regulated parties and community partners. The board recorded no formal public opposition during the hearing.

Votes at a glance: The board approved adoption of the HHSA fee schedule changes, effective July 1, 2025, by a 5–0 vote.

Sources: Presentation and public hearing by Rob Stewart, Fiscal Operations Director, HHSA; Tulare County Board of Supervisors public hearing, April 8, 2025.