Performance Measure(s): | |||
|
Measure |
2004 |
2005 | |
Percentage of applications screened through modified One-e-App tool that are determined eligible or preliminarily eligible for the following: |
N/A |
||
- |
Adult Medi-Cal |
30% | |
- |
Other Governmental Programs |
15% | |
- |
WELL Program |
35% | |
- |
Discounted Health Care (charity care discount |
10% | |
- |
Self-Pay |
10% | |
Percentage of applications that convert to Self-Pay status after 45 days because applicant did not bring in documents to prove eligibility |
N/A |
15% * | |
* After One-e-App modifications are in place; data will be collected from October 24, 2005 – March 31, 2006. | |||
|
BACKGROUND: | |||
In early 2003, your Board approved a contract with Deloitte Consulting to begin the development and implementation of the One-e-App tool to process applications for the Children’s Health Initiative programs (Medi-Cal for Children, Healthy Families, Healthy Kids) and the WELL Program for adults. With One-e-App’s ‘one-stop shop’ concept, uninsured families complete only one application to apply for all health insurance programs. One-e-App’s valuable features include eligibility calculation logics for all programs and the validation of all required data fields and verification documents, resulting in a low 5% error rate in determining program eligibility. | |||
Effective June 1, 2005, the One-e-App Program Office under the umbrella of the Public Health Institute took over the One-e-App maintenance and application Development from Deloitte Consulting. The One-e-App Program Office, created earlier this year, is a new non-profit organization funded by the two original One-e-App funders: the California Healthcare Foundation and the California Endowment. The Program Office will manage the on-going maintenance of the system for all One-e-App counties in the state. This consortium approach ensures that One-e-App counties such as San Mateo County will have the lowest cost possible for maintenance. The County entered into an agreement with the Public Health Institute One-e-App Program Office effective as of July 1, 2005. | |||
DISCUSSION: | |||
In May 2005, a County Medically Indigent Healthcare Work Group with representatives from the San Mateo Medical Center (SMMC), Health Department, Human Services Agency, County Manager’s Office, Revenue Services (Employee and Public Services), Controller’s Office, and County Counsel, completed a report and made recommendations toward creating a long-term financially viable business model for providing healthcare to the County’s medically indigent population. Major recommendations included: | |||
- |
Eliminating the self-declaration process currently in place for the County’s WELL Program for the medically indigent; | ||
- |
Establishing a full screening process conducted by staff from SMMC, the Health Department and community-based organizations (CBOs) that requires WELL applicants to show proof of residency and income; | ||
- |
Creating a charity care policy that mirrors those of private hospitals in the area; | ||
- |
Modifying the One-e-App web-based application processing system to screen for other non-County payor sources, including Adult Medi-Cal; | ||
- |
Reviewing 20% of WELL and charity care applications by the Human Services Agency using tools not available to SMMC, Health Department and CBOs; | ||
- |
Defining the County’s obligation for medically indigent healthcare under section 17000 of the Welfare and Institutions Code; | ||
- |
Finalizing a Memorandum of Understanding (MOU) with SMMC for provision of services to meet the County’s section 17000 obligation; and, | ||
- |
Developing a charity care ordinance modeled after San Francisco, which would require annual publication and dissemination of charity care statistics for all hospitals in the County. | ||
As part of the FY 2005-06 budget, your Board approved funds to conduct a pilot study that would implement the full screening process. At the request of the implementation workgroup led by the County Manager’s Office, the Health Department seeks to amend the agreement to integrate the following programs into the One-e-App system: inclusion of Adult Medi-Cal and the new Discounted Health Care (DHC/charity care) Program requirements, incorporation of the new screening and verification requirements for the WELL Program and the DHC Program, preliminary screening for other non-County payor sources, identification of all ineligible applications as ‘Self Pay’, and development of a review process for 20% of WELL and DHC applications by the Human Services Agency. | |||
In addition to ensuring that all uninsured adults will be properly screened in every available health insurance program, these system modifications will assist in achieving the county’s goals of developing a long-term financially viable business model that: (1) meets the County’s Welfare and Institutions Code Section 17000 responsibilities for medically indigent healthcare in a cost-effective manner, (2) defines responsibilities and costs between the County General Fund and San Mateo Medical Center (SMMC) Enterprise Fund, and (3) provides a stable funding source to SMMC for the medically indigent population. | |||
This contract was reviewed by County Counsel and by ISD. | |||
FISCAL IMPACT: | |||
The amendment increases the contract by $176,000, from $98,580 to $274,580. The term of the agreement remains July 1, 2005 through June 30, 2006. Human Services Agency will pay $65,985 of the increase in the contract to cover the Adult Medi-Cal and program audit components. The remaining balance of $110,015.00 represents Net County Cost. This will be funded by the FY 2005-06 Non-Departmental Services budget as part of the Medically Indigent Healthcare pilot study. | |||
