COUNTY OF SAN MATEO

Inter-Departmental Correspondence

Health Department

DATE:

September 29, 2006

BOARD MEETING DATE:

October 17, 2006

SPECIAL NOTICE/HEARING:

None

VOTE REQUIRED:

Majority

TO:

Honorable Board of Supervisors

FROM:

Charlene A. Silva, Director, Health Department

Srija Srinivasan, Director, Health Policy, Planning and Promotion

SUBJECT:

San Mateo Health Commission Contract for Healthy Kids

RECOMMENDATION:

Adopt a resolution:

1)

Authorizing an Amendment to the Agreement with the San Mateo Health Commission at a new rate not to exceed $91.45 per-member per-month effective February 12, 2006, adding $56,653 for retention efforts, and changing the contracting agency name from the San Mateo Health Commission to the San Mateo Community Health Authority, with no change to the term of the Agreement.

2)

Authorizing the Director of Health to execute subsequent amendments and minor modifications not to exceed an aggregate of $25,000 and to make minor changes in the types of services and activities provided under the Agreement.

VISION ALIGNMENT:

Commitment: Ensure basic health and safety for all.

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

The contract contributes to this commitment and goal by ensuring health care coverage for all children from low-income and middle-income families under 400% of the federal poverty level.

Performance Measures:

Measure

2005
Actual

2006
Projected

Medi-Cal (MC) membership for children

13,500

13,700

Healthy Families (HF) membership

8,100

8,300

Healthy Kids (HK) membership

5,800

6,000

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 uninsured children comprehensive medical, dental and vision health insurance coverage. In January 2003, the County moved 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.

The San Mateo Health Commission, doing business as the Health Plan of San Mateo (HPSM), serves as the contracted plan administrator for Healthy Kids under an agreement approved by your Board in May 2005, for the term February 2005 through February 2008. The current agreement includes an “at-risk” premium arrangement through which HPSM receives a payment rate of $92.15 per-member per-month. In February 2006, the Department of Managed Health Care approved a license for HPSM under the name of the San Mateo Community Health Authority (SMCHA); as a result, the administration of the Healthy Kids product was transferred from the San Mateo Health Commission to the SMCHA.

DISCUSSION:

The San Mateo Health Commission seeks to amend its contract with the County to continue providing health insurance for Healthy Kids members through a network of public and private providers. The amendment was delayed for approval by your Board due to revisions by HPSM staff.

This Amendment changes the premium from $92.15 to $91.45 per-member per-month based on available funding from the Children’s Health Initiative. HPSM will also be paid a maximum amount of $56,653 for retention efforts targeting families with children up to age five. The Amendment also acknowledges the change in administration of the Healthy Kids product from San Mateo Health Commission to San Mateo Community Health Authority.

The Amendment has been reviewed and approved by County Counsel and Risk Management. The Contractor has assured compliance with the County’s Contractor Employee Jury Service Ordinance, as well as all other contract provisions that are required by County Ordinance and administrative memoranda, including but not limited to insurance, hold harmless, non-discrimination, and equal benefits.

FISCAL IMPACT:

The term of this agreement remains February 12, 2005 through February 11, 2008. The approved CHI budget for 2006-07 is $8.3 million, which includes funding for premiums, administration, evaluation, outreach, enrollment and retention activities. Of this amount, $5.6 million is covered with contributions from First 5 San Mateo County, Peninsula and Sequoia Healthcare Districts, and foundations; the County’s Solid Waste Fund contributes $2.7 million. These funds, including costs associated with this Amendment, have been included in the FY 2006-07 Adopted Budget. There is no Net County Cost.