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COUNTY OF SAN MATEO
Inter-Departmental Correspondence
County Manager
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DATE:
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November 17, 2009
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BOARD MEETING DATE:
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December 15, 2009
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SPECIAL NOTICE/HEARING:
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None
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VOTE REQUIRED:
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Majority
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TO:
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Honorable Board of Supervisors
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FROM:
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Jean S. Fraser, Chief, Health System
Michael P. Murphy, County Counsel
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SUBJECT:
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Medically Indigent Policy Revisions
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RECOMMENDATION:
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Adopt a Resolution accepting the revisions to the County’s Healthcare for the Medically Indigent policy, in alignment with the County’s Welfare and Institutions Code Section 17000 responsibilities.
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BACKGROUND:
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By State law, Section 17000 of the Welfare and Institutions Code, counties are obligated to meet the healthcare needs of the medically indigent. San Mateo County fulfills its Section 17000 responsibility through a health coverage program available to San Mateo County residents with income below 200% of the Federal Poverty Level. Originally called the Wellness, Education, Linkages, Low-Cost (WELL) program, the name of this program was changed to Access and Care for Everyone (ACE) in January 2009.
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In November 2008 your Board approved an agreement with the Health Plan of San Mateo (HPSM) for administration of the consolidated ACE program, which incorporated the WELL program under HPSM’s administration and changed the name of the overall program to ACE. ACE is financed through the Federal and State funded three-year “Coverage Initiative” program awarded to ten counties in the State of California through a competitive application process. ACE County is the locally funded indigent care program.
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The medically indigent policy outlines the specifics of the ACE program. It includes scope of services, eligibility requirements, and enrollment, appeals and waiver processes. The County’s Healthcare for the Medically Indigent policy was last revised in October 2008.
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DISCUSSION:
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In follow-up to the October 2008 revision to the Medically Indigent policy, the Health System convened several meetings of stakeholders who had concerns about aspects of the administration of the ACE program, communication with clients, and levels of client cost-sharing. The group also discussed options for assuring that indigent clients’ medical bills are not excessive within the financial resources available to support indigent care. Based on the feedback, the Health System revised materials such as the ACE program brochure, the language included on San Mateo Medical Center bills for medical services and notification of clients’ opportunities to pursue appeals of eligibility and cost-sharing decisions. The Health System researched practices in other systems, and considered the financial and operational feasibility of potential changes.
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The revisions contained in the Medically Indigent policy incorporate the following changes: 1) implementing an out-of-pocket maximum of $1,000 for any individual enrolled in the ACE program; 2) incorporating the name change from WELL to ACE; 3) clarifying language about the application of discounts for residents eligible for the Discounted Health Care program; 4) eliminating language that requires the Health System to return ACE enrollment fees to clients who do not access services; and 5) aligning timeframes for the application and appeals process steps with Medi-Cal practices and experience in administering appeals related to the ACE program.
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Approval of the revised policy contributes to the Shared Vision 2025 outcome of a Healthy Community by enabling the Health System to continue meeting the County’s responsibilities to its medically indigent residents, balancing low-income clients’ ability to pay for medical services with administrative efficiency and fiscal integrity in delivering medical care. It is anticipated that more than 14,000 low-income clients will obtain medical care through the ACE program.
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The resolution and policy were reviewed and approved by County Counsel.
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Performance Measure(s):
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Measure
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FY 2008-09
Actual
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FY 2009-10
Projected*
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Number of individuals enrolled
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ACE
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5,266
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4,100
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ACE County
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10,411
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10,000
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Total
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15,677
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14,100
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* ACE enrollment is already at 19,069.
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FISCAL IMPACT:
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There is no Net County Cost associated with adoption of this Resolution. The San Mateo Medical Center FY 2009-10 Adopted Budget incorporates the costs of meeting the County’s Section 17000 responsibilities.
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