COUNTY OF SAN MATEO

Inter-Departmental Correspondence

Health Services Agency

DATE:

July 22, 2004

BOARD MEETING DATE:

August 31, 2004

TO:

Honorable Board of Supervisors

FROM:

Charlene A. Silva, Director of Health Services
Lisa L. Mancini, Director of Aging and Adult Services

SUBJECT:

Agreement with State Department of Health for the AIDS Medi-Cal Waiver Program

Recommendation

Adopt a resolution authorizing the President of the Board of Supervisors to execute Agreement Number 03-76075 with the State Department of Health for the AIDS Medi-Cal Waiver Program

Background

Aging and Adult Services operates two programs for people with AIDS or symptomatic HIV. The AIDS Case Management Program was developed to enable individuals with AIDS or symptomatic HIV to remain living independently in the community. Funding for this program is provided through a set grant allocation from the State. Establishment of the AIDS Medi-Cal Waiver Program added a second tier of assistance to the existing AIDS Case Management Program services within Aging and Adult Services (AAS), thus providing services to a larger number of individuals with HIV disease.

Through the use of subcontractors, both of these programs provide comprehensive social and health care management, skilled nursing, attendant care, psycho-social counseling, durable medical equipment, minor modifications to homes and transportation services to clients who are at risk due to deterioration of health, related to the HIV disease. Inclusion of the AIDS Medi-Cal Waiver Program has allowed AAS to increase the number of clients served and assist seriously ill clients to stay in their own homes as an alternative to being placed in a long-term care facility.

Discussion

The AIDS Medi-Cal Waiver Program is designed to reduce inpatient hospitalization by extending community care capacity for HIV patients with higher acuity and a broader range of service needs. This program makes Medi-Cal available as an additional funding source with eligibility limited to clients in the more advanced stages of the HIV disease. Reimbursement for AIDS Waiver services is on a fee-for-service basis through Medi-Cal. An annual cost cap per client of $13,209 affords a significantly higher level of services than is available through the AIDS Case Management Program.

The coexistence of the AIDS Case Management and AIDS Waiver Programs allows staff to move more acute clients from the Case Management Program to the Waiver Program, thus freeing up slots and enabling Aging and Adult Services to serve more clients. Services and items provided under both programs are similar (e.g., case management, skilled nursing, attendant care, psycho-social counseling and durable medical equipment, etc.).

Both the AIDS Case Management and AIDS Waiver Programs were reduced by 50% in fiscal year 2003-04, as a result of limited resources to meet the programs’ requirements. Currently, the AIDS Waiver Program allows Aging and Adult Services to serve 20 clients per month in addition to the clients served by the AIDS Case Management Program, which is required by contract to maintain an active caseload of 15-23 clients per month.

County Counsel has reviewed and approved this Agreement as to form and content.

Vision Alignment

The agreement with the Department of Health Services for AIDS Medi-Cal Waiver Program keeps the commitment of ensuring basic health and safety for all and goal number 8: People-Help vulnerable people—the aged, disabled, mentally ill, at-risk youth and others—achieve a better quality of life. Funds for the AIDS Medi-Cal Waiver Program will contribute to this commitment and goal by providing case management, skilled nursing, attendant care, psycho-social counseling, durable medical equipment, minor modifications to homes, and transportation services to people with AIDS or symptomatic HIV.

Fiscal Impact

The term of this Agreement is January 1, 2004 through December 31, 2006. Aging and Adult Services received this Agreement from the California Department of Health Services near the end of June 2004, and as a result we are now bringing it to your Board for approval. This program is funded through fee-for-service Medi-Cal with an annual cost cap per client of up to $13,209. For calendar year 2003, the average amount claimed for AIDS Waiver per client was $8,108. Revenues and expenses related to this Agreement are included in AAS’s adopted budgets for 2003-04 and 2004-05. The estimated annual budget for the AIDS Waiver Program is $230,000. There is no impact to the County General Fund as a result of this action.