Though his office was awarded a $1.5 million grant that will allow youth in their care to either connect or reconnect with Medi-Cal upon release from a detention facility, Lonnie Reyman isn’t thrilled.

Reyman, Del Norte County’s chief probation officer, told supervisors on Tuesday that he’ll likely use the CalAIM PATH 3 grant to hire a consultant to help create a plan for implementing the state-mandated program. But having to suddenly navigate the nuances of the “healthcare world” while relying on technical assistance from those who are also still figuring the program out is irritating, he said.

Reyman used a conversation he had during an October technical assistance call with teams from the University of California, Davis who, he said, were working with the state to help guide him and other counties through the program.

“One of the first things I said on that call to those folks was, ‘Honestly, I can’t keep track of everything that’s happening in the CalAIM space. There is no way for me to do that, I’ve got so many other things going on, what is this about?’” Reyman told supervisors. “Their response to me was, in my mind, indicative of all of this: ‘Well, it’s all we can do to try and keep track of all the changes too.’ And these are the people that are supposed to be telling me how best to implement and utilize these funds with the changes that the Department of Health Care Services and the state have mandated that I [must now] fulfill.”

Del Norte County supervisors on Tuesday unanimously authorized Reyman’s acceptance of the $1.5 million CalAIM PATH 3 grant. The grant is part of the state’s broader California Advancing and Innovating Medi-Cal initiative, which includes offering services to incarcerated adults and youth for up to 90 days before they’re released.

Those “pre-release Medi-Cal” services include arranging diagnosis, treatment and management of health conditions, access to laboratory and radiology exams, medication-assisted therapy as well as counseling and access to prescription and over-the-counter drugs and durable medical equipment upon release.

The Department of Health Care Services is offering Providing Access and Transforming Health Initiative, or PATH, grant dollars to correctional facilities and county social service agencies to cover start-up and planning costs to start offering those services.

“We have, in the past, been awarded PATH 2 [funds], and that was more for infrastructure, space for families and staff to meet together to work through applications and technological upgrades we might need,” Reyman told supervisors. “PATH 3, right now it’s a matter of let’s figure out what we need to do and what we can do.”

Pointing out that “technically we don’t have a juvenile hall locally,” District 2 Supervisor Valerie Starkey wondered how Del Norte would be eligible for PATH dollars. The county contracts with Humboldt, Mendocino and Shasta to house its incarcerated youth, which led Starkey to ask if a unified process with all four counties would be necessary to meet the program’s requirements.

Starkey noted that the Del Norte County Sheriff’s Office is working with the local Department of Health and Human Services to offer similar pre-release Medi-Cal services the CalAIM initiative requires, adding that it must be implemented by March 2026.

The Probation Office is operating under the same deadline, Reyman said. And, while Del Norte County no longer has a juvenile detention facility, having shuttered it about a year and a half ago, it’s still required to ensure Medi-Cal is available to its wards upon release, he said.

The chief probation officer used Lassen County as an example, saying that it’s been more than six years since its juvenile hall closed. Since Lassen relies primarily on Shasta County to house its incarcerated youth, they’ve come up with a template for how to coordinate those Medi-Cal services, Reyman said.

“The county that’s housing the kids, the kids are physically in their space and so [for] meetings that occur, things like that, they have their own plan for how that is to work and so there has to be coordination between the two,” he said. “Lassen and Shasta have come up with an agreement that they’ve passed off to other counties to utilize as a template if that’s something we desire to do.”

That coordination would be something Del Norte, Humboldt, Mendocino and Shasta would have to work out, Reyman said.

Probation is also partnering with the Department of Health and Human Services since it’s the parents, not the incarcerated youth themselves, that are applying for Medi-Cal, Reyman said.

“There’s coordination there to make sure that the family is sitting in front of the right person that can walk them through that application and make sure those documentary pieces are in place to make sure that Medi-Cal is either activated or remains active while that kid is in custody,” he said.

Despite receiving grant dollars to lay the foundation to ensure incarcerated youth aren’t without needed mental and physical health support through Medi-Cal, Reyman said one challenge is that the state isn’t going to keep paying for it.

Predicting that within five to seven years, “there is no more CalAIM money,” it will be up to Del Norte County to bill Medi-Cal for those services, Reyman said. But Medi-Cal won’t pay the entire bill either, he said.

“The county is going to be on the hook for the rest of this,” he said. “And that applies to my world with juvenile corrections. That applies to the adult world in the county jail. That applies in state prison. That applies across the board whenever you see these services brought whether it’s criminal justice or otherwise.”

Both District 5 Supervisor Dean Wilson and his District 3 colleague Chris Howard blamed state officials for coming up with a program it’s asking counties to implement without thinking how it’s going to affect them.

Wilson, who had been Del Norte County sheriff from 2002 to 2014, said the problem was that once someone was incarcerated they lost any Medi-Cal services they had prior to being arrested. There was no system in place to get them reinstated once those former inmates were released, Wilson said. To him, getting those individuals reinstated was “a simple fix to get them enrolled before they hit the ground running.”

Wilson accused the state of taking a simple process and making it “as complicated as possible.”

“It’s nice there’s a potential for us to recoup some dollar figure that we expend anyway because we’re going to have to provide all medical for all inmates,” Wilson said. “I can see that there’s going to be some amendments or changes to the contracts because most of these jails are having increased personnel to deal with the Medi-Cal issue and the treatment will be done outside of [what] the county provided at its facility to the juveniles, that’ll be reflected, increased costs or changes to our contracts. Does this money allow for that cost increase?”
Reyman said he had no way to answer that question. He said the grant dollars don’t cover increased cost for medical care, but rather all the planning that goes into getting that care reinstated once an incarcerated youth is set to be released to society. This includes coordinating with medical doctors, dentists, optometrists and other healthcare needs, he said.

“It’s possible that we would see some contractual changes based on what those counties are having to deal with while their own kids are in custody,” Reyman said. “I have no way to project what that would be or how those two things interconnect.”

Howard referred to work his wife, Lisa Howard, is having to do with the Del Norte County Unified School District when it comes to billing Medi-Cal for services. He urged his colleagues to communicate with Del Norte’s state representatives to push back against “unfunded mandates.”

“It’s to the point where we can hardly lift them anymore,” Howard said. “It’s like Atlas with the globe on his shoulders. That’s where we’re at.”