COUNTY OF SAN MATEO

Inter-Departmental Correspondence

Health Department

DATE:

April 20, 2005

BOARD MEETING DATE:

May 24, 2005

SPECIAL NOTICE/HEARING:

None

VOTE REQUIRED:

Majority

TO:

Honorable Board of Supervisors

FROM:

Charlene A. Silva, Director, Health Department

SUBJECT:

Health Plan of San Mateo Contract for Healthy Kids

RECOMMENDATION:

Adopt a resolution authorizing the President of the Board to execute an agreement between the Children’s Health Initiative and the San Mateo Health Commission for the period February 12, 2005 – February 11, 2008 at an amount not to exceed $92.15 per member per month.

VISION ALIGNMENT:

Commitment: Ensure basic health and safety for all.

Goal: 5: Residents have access to healthcare and preventative care.

The contract contributes to this commitment and goal by providing health care coverage to all children from low-income and middle-income families.

Performance Measure(s):

Measure

2004
Actual

2005
Projected

Medi-Cal membership for children

20,580

21,000

Healthy Families membership

7,514

8,100

Healthy Kids membership

5,170

5,900

BACKGROUND:

In 2002 your Board established and funded the San Mateo County Children’s Health Initiative (CHI) to address community-wide concern for the 17,000 county children who lacked access to comprehensive health insurance coverage. With your actions, a broad-based, local coalition collaborated to develop and implement an initiative that offers all children residing in low-income and middle-income households comprehensive medical, dental and vision health insurance coverage. In January 2003, the Coalition moved the County closer to the Board’s vision of 100 percent coverage for children by implementing the new Healthy Kids insurance program to cover all children ineligible for the existing Medi-Cal and Healthy Families programs and by expanding outreach and enrollment efforts, reaching out to the unions, childcare organizations, schools, and faith-based organizations.

The San Mateo Health Commission, doing business as the Health Plan of San Mateo (HPSM), serves as the contracted plan administrator for Healthy Kids, receiving a monthly per-member per-month (PMPM) premium, under an “at-risk” arrangement, to provide comprehensive health benefits. Current enrollment in Healthy Kids is 5,500.

DISCUSSION:

The Health Plan of San Mateo (HPSM) seeks to renew its contract with the Children’s Health Initiative to continue providing health insurance for Healthy Kids members. It will provide comprehensive medical, dental, mental health, and vision benefits through a network of public and private providers. The HPSM’s responsibilities will also include member services, Healthy Kids family contribution collection, provider recruitment to expand access, and activities to increase Healthy Kids retention of benefits. The contract was delayed for approval by your Board due to revisions by HPSM staff.

HPSM will be paid a $92.15 per member, per month premium based on available funding from the Children’s Health Initiative. HPSM will also be paid a maximum amount of $48,750 for retention efforts targeting families with children age 0-5.

HPSM will return 80 percent of any year-end Healthy Kids funding surplus (i.e., the remainder when collected premiums are subtracted from the cost of providing health care services) to the County, which will use the funds to cover future Healthy Kids premiums. The Commission will retain 20% of the surplus to offset the cost of administering Healthy Kids, to improve the quality of health care services provided to those with limited means.

The Coalition projects that it has sufficient funding each year to cover 6,000 Healthy Kids members for one full year. The Coalition will continue to pursue grant opportunities to expand its funding base and prevent an enrollment cap.

FISCAL IMPACT:

Approval of this item has no impact on the County General Fund. The approved CHI budget for Fiscal Year 04-05 is $8.2 million which includes funding for premiums, administration, evaluation, and outreach, enrollment, and retention activities. $5.5 million is covered with contributions from First 5 San Mateo County, Peninsula and Sequoia health care districts, and foundations; the County’s Solid Waste Fund contributes $2.7 million. The projected budget for Fiscal Year 05-06 is $8.3 million.