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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 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.
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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) 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 ...
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