Sheriff seeks to shift jail billing to America Choice to capture CalAIM reimbursements as board balks at $13.8M backfill

The San Diego County Sheriff’s Office asked the Board of Supervisors on March 24 for authorization to amend its jail medical administrative services agreement and to seek a countywide solicitation for an administrative services organization (ASO), saying a change could stabilize hospital costs and allow the county to capture state Medicaid (CalAIM) reimbursements for 90‑day pre‑release services.

Sheriff Kelly Martinez and medical staff told the board that NavCare, the current contractor, has struggled to implement pre‑release billing and to negotiate favorable off‑site hospital rates, leaving the sheriff’s office exposed when off‑site claims exceed a previously negotiated cap. Commander Jesse Johns, who oversees medical services, said the sheriff’s medical division projects roughly $26.9 million in off‑site claims for the current contract year and expects an additional $7.6 million in over‑cap liability by May 31, 2026.

The sheriff’s office proposed moving administrative billing to America Choice (referred to in staff materials as Amerit/America Choice), arguing the company has experience implementing CalAIM billing and existing relationships with local hospitals and county programs. Johns said the shift would support claims processing for pre‑release services (clinical consultations, medications, diagnostic studies and durable medical equipment) that, under the state’s CalAIM waiver, can be reimbursed for certain medically necessary services provided in the 90 days before release.

Sheriff’s staff asked the board to: 1) allocate $13.8 million from a community corrections subaccount to cover past and projected overages under the NavCare contract; 2) waive competitive procurement to amend the ASO contract with UnitedHealthcare/Amerit Choice pending negotiation; and 3) authorize a future countywide competitive solicitation at the conclusion of the existing contract.

Board action and debate: Chair Pro Tem moved a substitute motion to bifurcate recommendation one (the $13.8 million appropriation) from the remainder and to advance recommendations two and three plus a new recommendation requiring regular public reporting on off‑site medical expenditures and CalAIM enrollment. That substitute motion passed (with one supervisor voting no). A later motion to approve the $13.8 million appropriation failed on a separate vote.

Supervisors pressed staff for more detail about the expected CalAIM enrollment and the net fiscal impact. Several members said they could support a move that captured reimbursements and improved hospital contracting, but asked that the contract include clear performance metrics, routine (bi‑monthly suggested) reporting on off‑site medical expenditures and enrollment, and stronger cost‑control provisions that would limit county exposure to unforeseeable overruns.

Sheriff Martinez acknowledged the county’s exposure under the current NavCare fixed‑price cap and said the county’s goals are fiscal stability and better continuity of care for justice‑involved individuals. Staff said Amerit/America Choice has implemented CalAIM billing for other county programs and could provide auditing and forecasting capabilities the sheriff’s office lacks.

What happens next: The board authorized proceeding with the ASO contract amendment and directed county purchasing to pursue a competitive solicitation process for the future ASO and network services per staff recommendations; negotiations and final contract terms will return to the board for approval. The sheriff agreed to provide more detailed written responses and to work toward the reporting and performance provisions requested by supervisors.

Why it matters: San Diego’s jail medical program operates a stated $180 million medical budget; off‑site hospital utilization and specialty care have driven a notable increase in costs. The county faces an immediate budgetary question about how to cover prior overages and how to structure any new contract so that the county can access CalAIM reimbursement without assuming disproportionate fiscal risk.

The board’s vote to advance the contract steps but not to fund the $13.8 million backfill leaves the sheriff with negotiated authority to pursue an ASO change while the outstanding budget gap remains unresolved. The sheriff and county staff said they will return with more financial detail and refined contract safeguards.

(Reporting in this article is based on the staff presentation and board debate during the March 24 meeting; budget figures and projections were presented by the sheriff's medical services team.)