Inter-Departmental Correspondence

Health System



September 28, 2010


October 19, 2010







Honorable Board of Supervisors


Jean S. Fraser, Chief, Health System

Susan Ehrlich, CEO, San Mateo Medical Center

Louise Rogers, Director, Behavioral Health and Recovery Services

Srija Srinivasan, Director of Strategic Operations


Financial Assistance Programs Policies Revisions



Adopt a Resolution:


Authorizing revisions to the Financial Assistance Programs policies; and



Authorizing the Chief of the Health System to develop policies or procedures necessary to clarify and/or adjust scope of coverage and benefits to track or conform with changes to State and/or federal law, regulations, or practice



Under Section 17000 of the California 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 that is available, generally, to County residents with incomes below 200% of the Federal Poverty Level (FPL) called Access and Care for Everyone (ACE).


The Financial Assistance Programs policies outline the eligibility requirements, scope of services, enrollment, appeals and waiver processes, and other parameters comprising the County’s indigent care program.


Your Board last amended these policies in December 2009 to implement revised patient cost-sharing and to implement a name change, and to clarify other administrative provisions.



During the past year, the Health System has experienced increased demand for services resulting from unemployment and the loss of employment-based health insurance. Given reduced resources, the Health System has developed proposed policies to prioritize the populations it will serve. Clients meeting the clinical criteria for Behavioral Health and Recovery Services (BHRS) treatment are among our high priority populations.


In addition, as we have implemented the ACE program, it has become clear that for the program to operate effectively there are benefit and coverage interpretations that need to be made administratively, within parameters set by your Board, without having to come to your Board in every case.


Finally, the State has made adjustments to programs that have necessitated changes to align our local coverage program with State policies. Under a new Medi-Cal waiver being negotiated by the State, a segment of the “Coverage Initiative” component of the ACE program will be required to follow Medicaid cost-sharing limits to prepare for eventual transition to Medi-Cal expansion included in the federal health reform law. Compliance with this requirement necessitates raising the threshold for eligibility for “fee waiver” status within the ACE program from an income level of 100% FPL to 133% FPL.


The revisions to Financial Assistance Programs policies proposed at this time include: 1) an extension of ACE eligibility to uninsured adult clients meeting the clinical criteria for services from BHRS when these clients have incomes or assets that exceed the ACE financial eligibility criteria; 2) vesting the Chief of the Health System or designee with authority to develop policies or procedures necessary to clarify and/or adjust scope of coverage and benefits to track or conform with changes to State and/or federal law, regulations, or practice; and 3) raising the income threshold for waiver of enrollment fees and copayments to 133% FPL.


County Counsel has reviewed and approved the policies and Resolution as to form.


Approval of the revised policies 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 23,400 low-income clients will obtain medical care through the ACE program.


Performance Measure(s):


FY 2009-10

FY 2010-11

Number of individuals enrolled in ACE



*The FY 10-11 enrollment projection was developed based on enrollment trends as of March, 2010.


The estimated annual Net County Cost associated with adoption of this Resolution is $200,000, representing a small portion of the overall costs for meeting the County’s Section 17000 responsibilities. The San Mateo Medical Center division FY 2010-11 Adopted Budget incorporates the costs of meeting these responsibilities.