Title
Health and Human Services Agency (HHSA) recommending the Board approve and authorize the Chair to sign the Extended Letter of Agreement (LOA) with Mountain Valley Health Plan (MVHP), also known as the Health Plan of San Joaquin (HSPJ), which continues the terms and rates of Medi-Cal reimbursement for authorized medically necessary services to MVHP/HPSJ members, for the effective period of January 1, 2025, through December 31, 2025, while a final master agreement is in development, to ensure HHSA and MVHP/HPSJ can meet implementation deadlines required by the California Department of Health Care Services.
FUNDING: 100% Federal Medi-Cal.
Body
DISCUSSION / BACKGROUND:
California’s Medi-Cal program, the largest state Medicaid program in the U.S., insures roughly one-third of the state's residents, providing vital health coverage for low-income children, adults, and people with disabilities. The San Joaquin County Health Commission (Commission) contracts with the DHCS to deliver a public managed care plan for Medi-Cal beneficiaries through the MVHP/HPSJ Local Initiative Two-Plan Medi-Cal Managed Care Plan Model. This plan has improved healthcare access and reimbursement rates for providers.
MVHP/HPSJ, a non-profit Health Maintenance Organization (HMO), has served the Central Valley for over two decades, focusing on primary and preventive care in collaboration with DHCS. Starting in 2021, the DHCS began expanding the Commission's plan to rural counties for greater local control. On December 14, 2021, the Board adopted Ordinance 5149, which authorized the County to join the Commission (Legistar File 21-1422).
Following the Board’s approvals in 2021 and 2023, MVHP/HPSJ expanded its Medi-Cal Managed Care Plan (MCP) coverage to include El Dorado and Alpine Counties, with a planned service start date of January 1, 2024. However, the actual implementation was dependent on finalizing a master agreement between HHSA and MVHP/HPSJ, which was to be based on a contract template provided by DHCS (Legistar Files 23-0924, 23-1915).
On December 5, 2023, due to issues with the DHCS-mandated contract template not aligning with the current scope of preventive services provided by HHSA Public Health and MVHP/HPSJ, the Board approved a temporary Extended Letter of Agreement (LOA). This LOA covered the period from January 1, 2024, to June 30, 2024, allowing time for revisions to the master contract template (Legistar File 23-1915). On June 25, 2024, the Board approved and signed a second Extended LOA for the period from July 1, 2024, to December 31, 2024 (Legistar File 24-1034). These LOAs, while not constituting a formal contract between the County and MVHP/HPSJ, enabled ongoing collaboration and progress toward a long-term agreement in line with DHCS evolving statewide Medi-Cal Managed Care framework.
As the master agreement is still under development, this agenda item presents a request for the Board to approve a renewal of the Extended LOA, this time covering the period from January 1, 2025, to December 31, 2025. This extension will continue to outline medical services and reimbursement rates for authorized medically necessary services to MVHP/HPSJ members.
HHSA recommends the Board approve this Extended LOA to ensure continuity of the provision of medically necessary services while the master agreement between HHSA and MVHP/HPSJ is being finalized, to ensure that both parties can meet implementation deadlines required by the DHCS, which will be presented to the Board once completed.
ALTERNATIVES:
Should the Board decline to approve this recommendation, the County could forfeit the opportunity to partner with the Health Plan of San Joaquin as the offered public plan of the Two Plan Model to improve health services for County Medi-Cal Members.
PRIOR BOARD ACTION:
1) 04/13/21, 21-0278, HHSA Letter of Intent for MMC
2) 08/31/21, 21-1362, Approval in Concept of HPSJ
3) 12/14/21, 21-1422, HHSA First Reading of Revised Ordinance
4) 06/06/23, 23-0924, Health Plan of San Joaquin Letter of Intent
5) 12/05/23, 23-1915, HHSA HPSJ Extension Letter of Agreement
6) 06/25/24, 24-1034, HHSA HPSJ/MVHP Extended LOA 7/1/24-12/31/24
OTHER DEPARTMENT / AGENCY INVOLVEMENT:
County Counsel
CAO RECOMMENDATION:
Approve as recommended.
FINANCIAL IMPACT:
There is no General Fund Cost associated with this agenda item. The covered medical services are reimbursed through 100% Federal Medi-Cal.
CLERK OF THE BOARD FOLLOW UP ACTIONS:
Clerk of the Board to obtain signature of Chair on one Extended Letter of Agreement 9125.
STRATEGIC PLAN COMPONENT:
N/A
CONTACT
Olivia Byron-Cooper, MPH, Director, Health and Human Services Agency