COUNTY OF SAN MATEO

Inter-Departmental Correspondence

Health System

DATE:

December 14, 2009

BOARD MEETING DATE:

January 26, 2009

SPECIAL NOTICE/HEARING:

None

VOTE REQUIRED:

Majority

TO:

Honorable Board of Supervisors

FROM:

Jean S. Fraser, Chief, Health System

Srija Srinivasan, Special Assistant to the County Manager, Health Policy and Planning

SUBJECT:

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

RECOMMENDATION:

Adopt a Resolution:

1. Waiving the Request for Proposals (RFP) process; and

2. Authorizing the President of the Board to execute the Agreement with the San Mateo Community Health Authority to administer the Healthy Kids program for a coverage rate of $74.47 per-member per-month effective January 1, 2010 through December 31, 2012, and up to $200,675 for retention efforts.

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 coverage. In January 2003 San Mateo County implemented the Healthy Kids (HK) insurance program to cover children ineligible for Medi-Cal (MC) and Healthy Families (HF) programs and initiated an outreach and enrollment strategy to enroll children in all three public 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, for the term February 12, 2005 through February 11, 2008. The Agreement was amended in October 2006 and June 2007 in order to continue funding, to provide retention efforts, and to include an “at-risk” premium arrangement through which the Authority receives a payment rate of $92.13 per-member per-month (PMPM).

In March 2007 your Board approved the transfer of governance of CHI to the Authority. CHI operational functions, such as overall financial administration, have been transferred to the Authority. In March 2008 your Board approved a recommendation to lower the HK PMPM rate from $92.13 to $74.47 after an analysis of the costs and trends of the program.

DISCUSSION:

The Authority seeks to renew its contract to continue providing health insurance for HK members. It will continue to provide comprehensive medical, dental, mental health, and vision benefits through a network of public and private providers. The Authority’s responsibilities will also include member services, HK family contribution collection, provider services, and activities to increase retention of benefits.

Since program inception in January 2003, approximately 14,942 children have been enrolled in HK. As of November 2, 2009, there are 5,976 HK members. Under this Agreement, the Authority will be paid a $74.47 PMPM premium based on available funding from the CHI. The Authority will also be paid a maximum amount of $200,675 for retention efforts targeting families with children up to eighteen years of age.

This Agreement has been delayed for your Board’s approval due to the required internal process of the Authority. Therefore, it will not be executed on its start date of January 1, 2010.

The Authority is the sole source provider of the HK program administration, and for this reason, the Health System is requesting a waiver of the RFP process. The Agreement and Resolution have been reviewed and approved by County Counsel.

Approval of this Agreement contributes to the Shared Vision 2025 outcome of a Healthy Community by providing health coverage for low-income children in San Mateo County, which promotes access to preventive and regular healthcare. The number of children enrolled is an indicator of the reach of the HK program.

Performance Measure(s):

Measure

FY 2008-09
Actual

FY 2009-10
Projected

Medi-Cal (*)

12,560

15,784

Healthy Families

10,260

10,677

Healthy Kids

6,080

6,300

(*) Children enrolled in Full Scope No Share-of-Cost Medi-Cal

FISCAL IMPACT:

The CHI total budget of approximately $7.8 million is funded by donor contributions from organizations, including First 5 San Mateo County; Peninsula and Sequoia Healthcare Districts; federal and state programs covering a subset of the Healthy Kids members; and from the County’s General Fund. Approximately $5.6 million of the CHI budget is allocated to the Healthy Kids premiums. Costs for this contract are included in the Health Policy & Planning (HPP) FY 2009-2010 Adopted Budget. Costs for subsequent years will be included in the HPP FY 2010-11 and FY 2011-12 budgets. The General Fund support allocated to this contract is $728,245 with the balance of approximately $7 million covered by funding from donor contributions and federal and state funding.