Inter-Departmental Correspondence

Health System



December 30, 2010


January 25, 2011







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


Low Income Health Program Documents



Adopt a Resolution authorizing the President of the Board of Supervisors to approve and execute any and all documents required for participation in the Low Income Health Program, effective January 1, 2011 through June 30, 2011.



In November, 2010, the State of California completed the negotiation of a waiver to the federal/state Medicaid program. This waiver is renegotiated every five years, and permits California to waive compliance with certain Medicaid rules to receive federal reimbursement for healthcare services to specified low-income residents. The waiver allows California counties to provide additional health coverage for low-income residents and to strengthen the healthcare safety net that serves a large proportion of Medicaid and other low-income residents. This 2010 waiver is framed as a “bridge to health reform,” in light of the 2014 implementation date for several of the major components of the federal health reform law.


The previous waiver included an expanded health coverage component for which San Mateo County and nine other counties successfully competed. Participation enabled the County’s Health System, in partnership with the Health Plan of San Mateo (HPSM), to implement a “Coverage Initiative” program and efforts to redesign primary care services that serve as a pilot of the Blue Ribbon Task Force for Adult Health Care Coverage Expansion recommendations. During the past three years, the ACE-Coverage Initiative program served more than 6,700 participants and the San Mateo Medical Center “Innovative Care Clinic” has demonstrated accomplishments in clinical excellence and cost-effectiveness.



The 2010 waiver includes an opportunity for all counties to offer a coverage component, called the Low Income Health Program (LIHP), for county residents meeting specified income and citizenship criteria. The Health System has been planning for this opportunity, both internally and with the State, to maximally leverage the federal funding available to support healthcare services to low-income residents. Participation in the LIHP will result in federal reimbursement for a portion of the Health System’s costs for physical and behavioral health services to qualified residents. The LIHP also includes new requirements to position local coverage programs to transition to expanded Medi-Cal coverage in 2014 through implementation of federal health reform. The State will require a formal application and other materials to document the County’s intent to participate in the LIHP.


The State plans to release the application for LIHP participation in early January with a deadline for submission of February 3, 2011. This application will require approval by your Board. At this time, the application components are not yet known. However, we expect that there will be documents requiring short turnaround approval by your Board to meet the aggressive timelines that the State has negotiated with the federal government. We recommend, therefore, that the President of the Board be granted the authority to approve any and all documents necessary to enable San Mateo County’s participation in LIHP. This authority does not preclude the Health System from bringing key documents detailing the program’s parameters to your Board for its consideration; rather it enables a mechanism to meet short timeframes, if required to do so by the State. The Health System anticipates implementation of the LIHP by July 1, 2011.


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


Approval of the Resolution contributes to the Shared Vision 2025 outcome of a Healthy Community by enabling the Health System to maximally leverage federal funding to support the provision of physical and behavioral health services to low-income residents. It is anticipated that 23,400 low-income clients will obtain healthcare through the ACE program.


Performance Measure:


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.


There is no Net County Cost impact of adopting this resolution as the LIHP will be implemented in FY 2011-12. The San Mateo Medical Center and Behavioral Health and Recovery Services divisions’ FY 2011-12 recommended budgets will incorporate the costs and revenues involved in LIHP participation.