COUNTY OF SAN MATEO

Inter-Departmental Correspondence

Aging and Adult Services

DATE:

April 5, 2007

BOARD MEETING DATE:

April 24, 2007

SPECIAL NOTICE/HEARING:

None

VOTE REQUIRED:

Majority

TO:

Honorable Board of Supervisors

FROM:

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

SUBJECT:

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

RECOMMENDATION:

Adopt a resolution:

1.

Authorizing the President of the Board to execute Agreement Number 06-55637 with the State Department of Health Services for the AIDS Medi-Cal Waiver Program for the term January 1, 2007 through December 31, 2009; and

2.

Authorizing the Health Department Director or the Director's designee to execute contract amendments which modify the County's maximum fiscal obligation by no more than $25,000 (in aggregate), and/or modify the contract term and/or services so long as the modified term or services is/are within the current or revised fiscal provisions.

VISION ALIGNMENT:

Commitment: Ensure Basic Health and Safety for All.

Goal: 8: Help vulnerable people—the aged, disabled, mentally ill, at-risk youth and others—achieve a better quality of life.

The AIDS Medi-Cal Waiver Program will contribute to this commitment and goal by providing case management, skilled nursing care, attendant care, psychotherapy, homemaker services, nutritional counseling, nutritional supplements, home delivered meals, specialized medical equipment and supplies, minor adaptations to the home, Medi-Cal supplements for infants and children in foster care, and non-emergency medical transportation services to people with HIV Disease or AIDS with current symptoms.

Performance Measure(s):

Measure

FY 2005-06
Actual

FY 2006-07
Projected

Percent of at-risk individuals maintained in a least restrictive setting through case management

95%*

93%

* The FY 2005-06 performance exceeded the division’s performance goal.

BACKGROUND:

Aging and Adult Services (AAS) operates two programs for people with HIV Disease or AIDS with current symptoms. The AIDS Case Management Program was developed to enable individuals with HIV Disease or AIDS with current symptoms 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 AAS, thus providing services to a larger number of individuals with HIV Disease.

Through the use of subcontractors, both of these programs provide comprehensive case management and home- and community-based care to Medi-Cal recipients with a written diagnosis from his/her attending physician, in lieu of placement in a nursing facility or hospital. Inclusion of the AIDS Medi-Cal Waiver Program has allowed AAS to increase the number of clients served and assist seriously ill clients within San Mateo County.

DISCUSSION:

The AIDS Medi-Cal Waiver Program is designed to maintain clients safely in their homes or residential setting and to avoid more costly institutional care. This program makes Medi-Cal available as an additional funding source with eligibility limited to clients in the more advanced stages of 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 AAS to serve more clients. Services and items provided under both programs are similar (e.g., case management, skilled nursing, attendant care, psycho-social counseling, durable medical equipment, etc.). Currently, the AIDS Waiver Program allows AAS 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 the resolution and Agreement as to form.

FISCAL IMPACT:

The term of this Agreement is January 1, 2007 through December 31, 2009. 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 2006, the average amount claimed for AIDS Waiver per client was $10,572. Revenues and expenses related to this Agreement are included in AAS’s FY 2006-07 Adopted Budget and FY 2007-08 Recommended Budget. 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.