COUNTY OF SAN MATEO

Inter-Departmental Correspondence

Health Department

DATE:

June 14, 2007

BOARD MEETING DATE:

June 26, 2007

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:

Second Amendment to the Agreement with San Mateo Community Health Authority for the Healthy Kids Program

RECOMMENDATION:

Adopt a Resolution authorizing the President of the Board to execute a Second Amendment to Agreement Number 067335 with the San Mateo Community Health Authority at a rate not to exceed $91.72 per-member per-month effective February 12, 2007 to May 31, 2007, and at a rate not to exceed $92.13 per-member per-month effective June 1, 2007 to February 11, 2008, and adding $53,031 for retention efforts, with no change to the term of the Agreement.

VISION ALIGNMENT:

Commitment: Ensure basic health and safety for all.

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

This Amendment contributes to this commitment and goal by ensuring healthcare coverage for all children whose family incomes are below 400% of the Federal Poverty Level.

Performance Measures:

Measure

FY 2005-06
Actual

FY 2006-07
Projected

Medi-Cal (MC) membership for children

24,058

26,005

Healthy Families (HF) membership

8,585

8,750

Healthy Kids (HK) membership

6,073

6,768

BACKGROUND:

In February 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. In January 2003 the County moved closer to the Board’s vision of 100% coverage for children by implementing the Healthy Kids (HK) insurance program to cover all children ineligible for Medi-Cal (MC) and Healthy Families (HF) programs and by expanding outreach and enrollment efforts for all three programs.

The San Mateo Community Health Authority (the Authority), as the governing body of the Health Plan of San Mateo (HPSM), is the contracted plan administrator for HK under an agreement approved by your Board in May 2005 by Resolution 067335, for the term February 12, 2005 to February 11, 2008. The Agreement was amended by Resolution 068340 in October 2006 to add funding for retention efforts and to include an “at-risk” premium arrangement through which the Authority receives a payment rate of $91.45 per-member per-month.

DISCUSSION:

In March 2007 your Board approved the transfer of governance of CHI to the Authority. CHI operational functions, such as overall financial administration and contracts management, are being transferred to the Authority in phases. The Health Department will continue to administer the above functions until the end of the contract term.

The Authority seeks to amend its contract with the County to continue providing health insurance for HK members through a network of public and private providers. The amendment was delayed for approval by your Board due to the required internal process of the Authority. This Amendment changes the premium from $91.45 to $91.72 per-member per-month from February 12, 2007 to May 31, 2007, and to $92.13 per-member per-month from June 1, 2007 to February 11, 2008. The first increase was due to the rate adjustment made by Delta Dental, the Authority’s dental subcontractor, in part due to growth of HK membership. The second rate increase will cover the costs of new outreach activities conducted by Delta Dental aimed at promoting dental utilization among HK members. The Authority will also be paid a maximum amount of $53,031 for retention efforts targeting families with children up to five years of age.

This Amendment has been reviewed and approved by County Counsel.

FISCAL IMPACT:

The term of the Agreement, February 12, 2005 to February 11, 2008, remains the same. The total approved budget for CHI for FY 2006-07 is $8.9 million: $6.2 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. Funding from the above mentioned sources will also be used to fund the Healthy Kids premiums and retention efforts for the upcoming fiscal year. The Recommended Budget for CHI for FY 2007-08 is $9.4 million, $6.7 million is covered with contributions from First 5 San Mateo County, Peninsula and Sequoia Healthcare Districts, foundations, and the CHI Trust Fund; the County’s Solid Waste Fund will contribute $1.5 million and the County’s General fund will contribute $1.2 million. Approval of this item has no Net County Cost impact.