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Health and Human Services Agency (HHSA) recommending the Board approve and authorize the Chair to sign the Extended Letter of Agreement (LOA) 9907 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 one-year period effective January 1, 2026, through December 31, 2026, with the option to extend the term of the LOA for up to two additional one-year terms after the initial term through December 31, 2028, while a final master agreement is in development between HHSA and MVHP.
FUNDING: 100% Federal Medi-Cal.
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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), a multi-county commission, contracts with the California Department of Health Care Services (DHCS) to provide a managed care health plan to Medi-Cal covered individuals. Through this managed health care plan, referred to as the Health Plan of San Joaquin (HPSJ) Two-Plan Medi-Cal Managed Care Plan Model, the Commission has successfully improved health care access for its members and increased reimbursement rates for health care providers.
The HPSJ is a non-profit Health Maintenance Organization (HMO) Managed Care Plan (MCP) that collaborates with the Medi-Cal Managed Care Division of the DHCS to deliver healthcare to Medi-Cal members and has been providing healthcare services to the Central Valley community for over two decades.
On June 6, 2023, the Board approved the execution of a Letter of Intent between HHSA and the HPSJ which expressed the parties’ mutual intent to negotiate and develop a formalized Medi-Cal Services Agreement to provide Medi-Cal covered services to HP...
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