Exhibit B Targeted Funding and Budget Request

Description

Exhibit B: YBHC Targeted Budget Request Summary Applicant Name: ___________________________ Program(s)/ Service(s): ___________________________ Instructions for Completion 1. Complete all applicable sections only if requesting County funding (Path A). 2. If your program does not require additional funding (Path B), no budget or narrative submission is necessary. Additional evaluation points will be added to base score. 3. Round all amounts to whole dollars. 4. Ensure totals in the summary table match itemized costs in justification tables. Funding Path Selected: ☐ Path A – Funding Request ☐ Path B – No Additional Funding 1. Summary of Request Budget Category Description / Purpose Personnel Staff directly supporting nonbillable, bridge, or expansion services Benefits for personnel requested above Consultants, temporary staff, or specialized services needed for start-up or expansion Program-specific supplies needed for gap-funded services Technology, equipment, training, or other operational needs not reimbursable Fringe Benefits Contractual Services Supplies Other Costs Amount Requested($) Funding Type (NonMedicaid / Bridge / Expansion) Total Request 2. Justification Tables Instructions: Use these tables to justify why the requested County funds are necessary, quantify expected reach, and demonstrate measurable outcomes. Below are tables for the following funding types: A. Non-Medicaid Services, B. Bridge/Start-Up, C. Regional Expansion A. Non-Medicaid Services: (Service / Activity – What you are delivering (e.g., group therapy sessions), Target Population – Who will benefit (e.g., underserved youth, ages 12–18), Frequency / Units – How often the service is delivered or number of units (e.g., 20 sessions per month), Cost ($) – How much it will cost for that service, Outcome / Impact – What result you expect (e.g., 80% of youth demonstrate improved coping skills). Service / Activity Target Population Frequency / Units Cost Outcome / Impact B. Bridge / Start-Up Funding: (Cost Item – Specific cost (e.g., credentialing fees, temporary staffing), Purpose / Need – Why this expense is necessary, Timeline to Medicaid Billing – When the service will start billing Medicaid, One-Time or Temporary – Whether this cost is short-term, Exit Strategy / Sustainability – How this cost will be covered once the program becomes self-sustaining.) Cost Item Purpose / Need Timeline to Medicaid Billing One-Time or Temporary Exit Strategy / Sustainability