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Health and Human Services Agency (HHSA) recommending the Board:
1) Approve and authorize the Chair to sign Agreement 9773 with the County of Santa Cruz, acting as the Host Entity for the Medi-Cal Administrative Activities and Targeted Case Management program, with a retroactive term of July 1, 2025, through June 30, 2028, with no stated maximum obligation (estimated obligation of $20,000);
2) Authorize the Purchasing Agent to execute amendments relating to Agreement 9773, contingent upon approval by County Counsel and Risk Management, which do not alter compensation or the term of the Agreement; and
3) Authorize the HHSA Director, or the Chief Assistant Director, to execute programmatic, administrative, and fiscal documents relating to Agreement 9773.
FUNDING: 100% Federal funding for Medi-Cal Administrative Activities.
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DISCUSSION / BACKGROUND:
The California Department of Health Care Services (DHCS) administers the California Medi-Cal Assistance (CMA) Program, of which the MAA and TCM program are components. DHCS contracts with participating CMA counties throughout the state, referred to as “Local Government Agencies” (LGAs), to ensure the appropriate administration of MAA and TCM services.
Through the CMA Program, the County as an LGA, contracts with DHCS to receive reimbursement for MAA and TCM services, to include outreach, referral coordination, case management, and assisting clients with completing a Medi-Cal application. The LGAs’ objective is to assist eligible Medi-Cal eligible residents gain access to needed medical, social, educational, and other services.
Under the CMA Program, a Host Entity is required to collect and disburse LGA participation fees, pursuant to the responsibilities outlined in California Welfare and Institutions Code Section (WIC) Section 14132.47(m). The Host Entity is identified and approved by the LGA Consortium and contracts with all LGAs participating in MAA/TCM program. The County of Santa Cruz is the Host Entity for the TCM program in California.
LGAs participating in the CMA Program are required to pay an annual participation fee to the Host Entity, required by state law as a condition of county participation in the MAA and TCM program. The MAA and TCM participation fees are determined annually based on the percentage of revenue received by each program. Host Entity total annual compensation is not the same nor equal to the LGA's annual participation fee.
As the Host Entity, the County of Santa Cruz emailed a partially signed agreement to HHSA in May 2025, indicating it would likely be retroactive due to the expiration of the previous Agreement 7725 on June 30, 2025. Since HHSA received the renewal agreement for execution so close to the expiration date of the prior agreement, bringing this retroactive Agreement 9773 before the Board is unavoidable due to contract and Board item processing time.
HHSA recommends approval of Agreement 9773, as it is required for the County to continue to participate in and receive federal revenues for MAA and TCM services. The annual payment of the LGA participation fee to the County of Santa Cruz (as the Host Entity) through this agreement is a requirement to participate in the CMA Program with DHCS. Through its participation in the program, the County may claim federal Medicaid matching funds for assisting the state in the proper and efficient administration of the Medi-Cal Program. HHSA acts as the liaison for receipt of MAA revenues for the County and has been participating in the CMA Program since 1998.
ALTERNATIVES:
Should the Board decline to approve this Agreement, HHSA would no longer be able to continue its long-term participation in the CMA Program. Approximately $90,000 in potential Medicaid revenue would be lost for HHSA programs participating in the CMA Program.
PRIOR BOARD ACTION:
1) 08/04/20, 20-0942, HHSA County of Santa Cruz Agreement 4993
2) 06/27/23, 23-0968, #7725 Co. of Santa Cruz Health Services Agency MAA/TCM
OTHER DEPARTMENT / AGENCY INVOLVEMENT:
County Counsel, Human Resources, and Risk Management.
CAO RECOMMENDATION:
Approve as recommended.
FINANCIAL IMPACT:
There is no Net County Cost associated with this agenda item. Sufficient appropriations were included in the Fiscal Year (FY) 2025-26 Budget and will be included in future budgets for the terms of the Agreement. The Public Guardian program and Community Services Division are participants in the CMA Program which brings in Federal Medi-Cal Administrative revenues. Not participating in MAA through this Agreement will increase the General Fund cost of the Public Guardian Program.
CLERK OF THE BOARD FOLLOW UP ACTIONS:
Clerk of the Board to obtain signature of Chair on one original Agreement 9773.
STRATEGIC PLAN COMPONENT:
N/A
CONTACT:
Olivia Byron-Cooper, MPH, Director, Health and Human Services Agency