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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) 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 July 1, 2024, through December 31, 2024, 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.
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DISCUSSION/BACKGROUND:
California’s Medi-Cal program, the largest state Medicaid program in the U.S., insures nearly 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 No. 5149, which authorized the County to join the Commission (Legistar File 21-1422).
Following the Board’s approvals in 2021 and 2023, MVHP/HPSJ extended its coverage as a Medi-Cal Managed Care Plan (MCP) to El Dorado and Alpine Counties, with the planned effective date for service provision being January 1, 2024. The actual effective date was contingent upon the establishment/execution of a master agreement between HHSA and MVHP/HPSJ, ...
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