COUNTY OF SAN MATEO

Inter-Departmental Correspondence

Health System

DATE:

September 9, 2010

BOARD MEETING DATE:

October 19, 2010

SPECIAL NOTICE/HEARING:

None

VOTE REQUIRED:

Majority

TO:

Honorable Board of Supervisors

FROM:

Jean S. Fraser, Chief, Health System
Susan Ehrlich, MD, MPP, Chief Executive Officer
San Mateo Medical Center

SUBJECT:

Acceptance of Grants from Sequoia Healthcare District

RECOMMENDATION:

Adopt a Resolution:

A)

Accepting grants from Sequoia Healthcare District: (1) one in the amount of $2,000,000 for FY 2010-11 to support San Mateo Medical Center’s indigent and uninsured residents of Sequoia Healthcare District and ratifying acceptance of similar grants of $1,600,000 in FY 2008-09 and $2,000,000 in FY 2009-10, and (2) one in the amount of $4,300,000 for a new South County Clinic; and

B)

Authorizing the Chief of the Health System to execute any and all documents and agreements associated with the funding for the South County Clinic.

BACKGROUND:

The population of the North Fair Oaks neighborhood continues to increase, along with the number of uninsured individuals who need medical care. During the past year, the Fair Oaks Adult and Children’s Clinics provided over 37,000 outpatient visits to more than 12,000 individuals living in or near the neighborhood. Moreover, more than 17% of all children’s visits and 37% of adult visits were for patients without insurance; they are enrolled in the San Mateo Medical Center’s (SMMC) indigent programs and unable to pay for care. As the County’s safety net public hospital, SMMC has a mission to provide medical services to the uninsured throughout its system of care. Paying for the cost of delivering this care is a perpetual challenge, and this burden cannot be handled by the County alone. Fair Oaks Clinics serves a patient population that resides primarily within the geographic boundaries of Sequoia Healthcare District (SHD). The SHD has further recognized the increasing need for medical care of its uninsured and low-income residents by committing $4.3 million toward the costs of building a new consolidated South County Clinic that would replace the Fair Oaks Adult and Children’s Clinics and the Willow Clinic.

DISCUSSION:

In July 2006, SMMC submitted a proposal to the Board of Directors of SHD, requesting that a portion of the funds held by the Board on behalf of the residents of the District be granted to SMMC for the purpose of covering the otherwise unreimbursed cost of providing outpatient primary medical care, ancillary services (laboratory, pharmacy, and radiology) and specialty medical care to the indigent and uninsured patients at its Fair Oaks Clinics. In September 2006 the Board of SHD agreed to this proposal and granted SMMC $1.6 million each year for two years for this purpose. In 2008 and 2009, the SHD Board renewed this commitment, granting SMMC $1.6 million and $2.0 million, respectively. Recently, the SHD Board granted another $2.0 million for FY 2010-11. The grants for FYs 2008-09 and 2009-10 were included in the adopted budgets for those years, but the grants were never formally accepted by your Board. As such, the acceptance of those grants needs to be ratified by this Board. Subsequent to the approval by your Board, the Chief of the Health System and County Counsel will develop a Memorandum of Understanding with the SHD for the contributions for the South County Clinic and staff recommends that the Chief of the Health System be delegated the authority to execute such agreement and any associated documents on behalf of the County.

In accepting the new $2,000,000 grant for the FY 2010-2011, the County agrees to: 1) demonstrate, on an ongoing basis, that the population served by these funds resides primarily within the boundaries of SHD; and 2) demonstrate, on an ongoing basis, that the costs charged against this funding are neither subject to nor eligible for reimbursement through government or private insurance programs. In accepting the $4,300,000 facility grant, the County will agree to use the funds for a new clinic and otherwise return the funds.

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

Acceptance of this grant contributes to the Shared Vision 2025 outcome of a Healthy Community by ensuring basic health and safety for all and providing residents access to healthcare and preventive care. It is anticipated that the 18 percent of visits at Fair Oaks Clinics will be funded by SHD.

Performance Measure:

Measure

FY 2009-10
Actual

FY 2010-11
Projected

Services to indigent and uninsured patients, funded through the SHD grant, provided by SMMC and Fair Oaks Clinics.

17%

18%

FISCAL IMPACT:

SMMC has received four grants between 2008 and 2011 for a total of $9,900,000. $1,600,000 was included in the SMMC FY 2008-09 Adopted Budget. $2,000,000 was included in the SMMC FY 2009-10 Adopted Budget. $2,000,000 is included in the SMMC FY 2010-11 Adopted Budget. Funding for the South County Clinic Consolidation Project will be held in a trust fund; an Appropriation Transfer Request will be brought to your Board with the full project approval.