Memorandum
Date: March 17, 2026
To: The Honorable Lake County Board of Supervisors
From: Susan Parker, County Administrative Officer
Stephen L. Carter, Jr., Assistant County Administrative Officer
Matthew Rothstein, Chief Deputy County Administrative Officer
Subject: Adopt Memorandum of Understanding (MOU) with the Golden State Finance Authority (GSFA) to provide cost reimbursement for participation in a regional Jail Medical Care Feasibility Study focused on evaluating long-term, sustainable alternatives for jail medical service delivery, and Authorize the Chair to sign
Executive Summary:
On September 18, 2025, County Administration signed and submitted a letter of formal request to be included in the Feasibility Study on long-term alternative for Jail Medical Care Request for Proposal. The Administrative Office met with Health Services, the Sheriff’s Office, and Behavioral Health before submitting the letter of formal request.
Counties throughout California are increasingly challenged by the rising cost and complexity of providing legally required medical care to individuals housed in county jails. Many face persistent staffing shortages, escalating contract and litigation costs, and increasing difficulty maintaining compliance with state and national care standards. These challenges are particularly pronounced in rural and mid-sized counties, where limited scale, geographic constraints, and workforce availability create additional barriers to service delivery.
Publicly available data and county experience indicate that contract costs for jail medical services have increased significantly from one contract period to the next, often alongside expanded regulatory requirements and heightened expectations for specialty and behavioral health care. At the same time, chronic workforce shortages have contributed to increased reliance on contract-based service models and temporary staffing arrangements, which can create operational instability and additional fiscal pressure. Limited service partner options amplify the counties’ concerns should one partner no longer be available.
In parallel, counties have observed increased litigation and liability exposure related to jail medical care, underscoring the financial and risk management implications of existing delivery models. In discussions with regional working groups, PRISM, a member-directed risk management joint powers authority, noted recent cases involving in-custody deaths and medical care claims that resulted in multimillion-dollar settlement demands and increased county costs.
In response to these shared challenges, the Rural County Representatives of California (RCRC), in partnership with PRISM, convened five regional task forces in early 2025 composed of County Executive and Administrative Officers (CEOs and CAOs). The purpose of these task forces was to explore long-term strategies for improving the delivery, quality, cost-effectiveness, and risk management of jail medical care, including the potential for regional collaboration.
Following a series of working group meetings with each region, the Golden State Finance Authority (GSFA), RCRC’s affiliated public agency, issued Request for Proposals (RFP No. 2025-GSFA-001) on October 13, 2025. The purpose of the RFP is to procure a qualified consultant, or team of consultants, to conduct a feasibility study evaluating alternative models for jail medical care delivery across five defined regions of California, encompassing a total of 26 participating counties (See EXHIBIT A for a map of participating counties within each region). The feasibility study is intended to support counties in assessing regional collaboration opportunities, cost-effective service delivery approaches, quality-of-care considerations, and compliance with applicable state and national standards (See Exhibit B for list of deliverables to be completed under the contract).
The RFP submission period closed on December 12, 2025, resulting in two qualifying proposals. GSFA conducted an internal evaluation process that included technical scoring and consultation with each CAO-led regional working group in early January 2026. Through this process, regional working groups identified preferred consultants to support the feasibility study within their respective regions.
This staff report is provided to support the Board’s consideration of the attached MOU related to participation in the Jail Medical Care Feasibility Study. Through the proposed MOU, the county would partner with the GSFA to fund and participate in a coordinated, data-driven evaluation of long-term jail medical care alternative alongside similarly situated counties. Under the anticipated structure, GSFA will serve as the contracting entity and program facilitator, convene coordination meetings between county staff and the selected consultant, and act as the fiscal intermediary responsible for processing and paying consultant invoices using funds contributed by participating counties. The feasibility study will be performed exclusively by the selected consultant, and the MOU will become effective only upon execution by all participating counties within the region.
Staff recommends your Board adopt the Memorandum of Understanding.
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Estimated Cost: __$26,510.94_ Amount Budgeted: $26,510.94 Additional Requested: ________ Future Annual Cost: ________
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Recommended Action: Adopt Memorandum of Understanding (MOU) with the Golden State Finance Authority (GSFA) to provide cost reimbursement for participation in a regional Jail Medical Care Feasibility Study focused on evaluating long-term, sustainable alternatives for jail medical service delivery, and Authorize the Chair to sign.