COUNTY OF SAN MATEO

Inter-Departmental Correspondence

County Manager

DATE:

August 12, 2002

BOARD MEETING DATE:

August 20, 2002

TO:

Honorable Board of Supervisors

FROM:

John L. Maltbie, County Manager

SUBJECT:

Children's Health Initiative

Recommendation

Adopt a resolution:.

1.

2.

3.

4.

5.

Establishing the Children's Health Initiative Coalition,

Naming the children's health insurance program "Healthy Kids",

Identifying the Peninsula Community Foundation as the Fundholder,

Appointing the Health Plan of San Mateo as the Plan Administrator, and

Designating the Health Services Agency as the lead agency of the Coalition

Background

An estimated 17,000 uninsured children live in San Mateo County, with 14,600 residing in households earning an annual income below 400% of the Federal Poverty Level (FPL) ($61, 000 for a family of three). With the advent of the San Mateo Community Access (CAP) Program, a number of County and community groups have been working for the past year on the development of a universal health care program, which would provide health insurance to all children up to 400% FPL who are not eligible for Medi-Cal or Healthy Families and who are not already enrolled in an employer-sponsored insurance program.

In March 2001, San Mateo Health Services Agency received a federal CAP grant to continue its work on creating a more coordinated approach to expanding health access by integrating health programs and services into a cohesive system of care for the uninsured. Since receiving the grant, Health Services along with its coalition partners, have met the grant objectives reaching such targets as increasing Medi-Cal enrollment by 38.5% and Healthy Families enrollment by nearly 60%.

With these successes, the CAP executive committee began investigating additional approaches to covering low-income children who are ineligible for Medi-Cal and Healthy Families due to income status or documentation. Earlier this year the executive committee formed a coalition to plan a Health Summit aimed at bringing together County stakeholders to understand the problem of uninsured children, examine successful models, and work towards providing universal health coverage to all County children. The Hospital Consortium of San Mateo County and the Peninsula Community Foundation were instrumental in funding this important community event.

At the Health Summit, which was held in May, the Children and Families First Commission announced that, at the recommendation of its Health Access Committee, the Commission would commit on-going funding in the amount of $2.3 million per year for ten years to insure children 0-6 years old living at or below 400% FPL (approximately 4,900 children). Fundraising efforts have begun to make up the difference to cover the full cost of ensuring all children (0-18), which is estimated to be $7.7 million.

Discussion

Since the San Mateo County Health Summit, Health Services has formed the Children's Health Initiative Coalition-a spin-off of the Health Summit planning committee--, to serve as the decision-making body for the planning and development of both the Healthy Kids Program and outreach and enrollment strategies that ensure comprehensive health coverage for all San Mateo County children. Many of CHI coalition members are also on the Executive Committee of Community Access Program. The CHI Coalition consists of the following representatives:

Hospital Consortium of San Mateo County: Tim McMurdo, Bob Hortop, Ron Robinson

Children and Families First Commission: Kris Perry, Michelle Fernandez

Central Labor Council: Shelly Kessler, Rayna Lehman

Peninsula Community Foundation: Srija Srinivasan

Health Plan of San Mateo: Michael Murray, Ellen Dunn-Malhotra

San Mateo County Health Service and Human Services Agencies: Margaret Taylor, Maureen Borland, Maya Atman, Glen Brooks, Elsa Dawson, Toby Douglas, Heather Ledesma

Representatives from these organizations also take lead roles in planning and facilitating subcommittees working on various aspects of the Initiative. The Hospital Consortium is the lead agency for the Fundraising and Marketing subcommittee. Human Services is the lead agency for the design of Outreach and Enrollment and Eligibility Determination subcommittees. The Health Plan of San Mateo is the lead agency for the Finance and Material Modification subcommittees. Health Services is the lead agency in the coordination of the Coalition's efforts and is taking the lead role in the evaluation of the Initiative. The Health Services Community Access Program (CAP) has been the springboard for the County's increased focus on outreach and enrollment into insurance programs and universal coverage for kids. The goals of CAP support the goals of the Coalition; thus designating Health Services as the lead agency of the Coalition will ensure close coordination and shared staffing between the two efforts.

At this point, it is recommended that the Board officially establish the Children's Health Initiative Coalition as the decision making body for the project to provide universal health care to all children in San Mateo County and name the newly developed insurance program "Healthy Kids" in an effort to create a seamless program with our surrounding counties. Further, as a result of meetings with the Peninsula Community Foundation (PCF) management, it is recommended that PCF be the Fundholder of private and public (non-County) funding raised for the Healthy Kids program. PCF will disperse the funds with oversight by members of the Coalition. It is also recommended that you officially appoint the Health Plan of San Mateo to be the Plan Administrator for Healthy Kids program. The Children and Families First Commission Health Access Committee has studied various managed care organizations and has identified the Health Plan of San Mateo as having the greatest capacity and qualifications to operate the Healthy Kids program, due to its focus on the uninsured and underserved populations, cultural competency and relationship with County agencies. Finally, the Coalition recommends designation of the Health Services Agency as the lead agency in the coordination of the Coalition's efforts, for reasons stated above.

Vision Alignment

The Children's Health Initiative Coalition's efforts keep the commitment of Ensuring Basic Health and Safety for All and goal number 5: Residents have access to health care and preventive care. The Coalition contributes to this commitment and goal by providing universal health care coverage to children 0-18 who live in households with annual incomes below 400% FPL.

Fiscal Impact

Start-up costs for the Healthy Kids program are estimated to be $1.7 million. At final budget hearings in September, the Coalition will present the on-going costs for your approval.