Title
Health and Human Services Agency recommending the Board provide conceptual approval, pursuant to Board Policy A-3, of the development of a new County Ordinance to satisfy the requirements to join the Health Plan of San Joaquin Medi-Cal Managed Care plan.
FUNDING: N/A
Body
DISCUSSION / BACKGROUND:
Board Policy A-3 "Ordinances - New or Amended" requires new ordinances to be presented to the Board of Supervisors for review and conceptual authorization to prepare the ordinance.
California’s Medicaid program, Medi-Cal, is the largest state Medicaid program in the nation. Providing insurance for almost one-third of California’s roughly 40 million residents, Medi-Cal is a key source of health coverage for low-income children, adults, and people with disabilities, while also providing wrap-around coverage for many elderly Medicare beneficiaries. California was the first state to pilot managed care in Medicaid, beginning in the early 1970s, and from that the Medi-Cal Managed Care (MMC) program has developed a unique structure that grew out of the different health care delivery and financing systems in different counties across the state. Over time, California has transitioned progressively more Medi-Cal beneficiaries into MMC, and through this Medi-Cal providers who wish to provide services to managed care enrollees must participate in the managed care plan’s provider network.
Working directly with Barton Health, Marshall Medical, El Dorado Community Health Center, Alpine County, and the Health and Human Services Agency (HHSA) of El Dorado County, it was determined that the best model for Medi-Cal Managed Care in the County would be to adopt a two-plan public/commercial model, one plan being available to residents through a private provider and the other through a Public Plan. The Health Plan of San Joaquin (HPSJ) was selected as this plan due to their geographic proximity to El Dorado County as well as their impressive statistics in regards to putting a much larger percentage of their funding received back into the communities they serve which results in increased providers and services for residents when compared to commercial private counterparts, who have shareholders. On April 13, 2021 (21-0278, Agenda #24), HHSA presented this recommendation from El Dorado's hospitals and community healthcare partners to the Board of Supervisors, thereafter approving and authorizing the Chair to sign a Letter of Intent to transition to the Health Plan of San Joaquin (HPSJ) Local Initiative Two-Plan public/commercial Medi-Cal Manager Care Plan Model. Subsequent to approval by the Board, HHSA and our countywide healthcare partners have continued to work with the State Department of Health Care Services (DHCS) to identify and meet the requirements to join HPSJ. One of the requirements is for each County to submit an ordinance to HPSJ as part of their package for submission to the State. The Ordinance is due to HPSJ no later than October 1, 2021.
ALTERNATIVES:
Should the Board decline to approve this recommendation, the County would be unable to participate in the new MMC plan through HPSJ. This would result in an outcome that is not recommended by HHSA or El Dorado's hospitals and community healthcare partners as it would lead to a missed opportunity to increase services and access for residents that rural counties have been seeking from the State over the past decade.
PRIOR BOARD ACTION:
April 13, 2021, File ID 21-0278, Agenda No. 24, “HHSA - Letter of Intent for MMC”
OTHER DEPARTMENT / AGENCY INVOLVEMENT:
N/A
CAO RECOMMENDATION:
Approve as recommended.
FINANCIAL IMPACT:
There is no cost associated with this Agenda Item. There is no impact to County funds associated with joining the Health Plan of San Joaquin Medi-Cal Managed Care (MMC) plan.
CLERK OF THE BOARD FOLLOW UP ACTIONS
Clerk of the Board to return one (1) certified Minute Order to HHSA Contracts Unit at 3057 Briw Rd, Suite B.
STRATEGIC PLAN COMPONENT:
Healthy Communities
CONTACT
Don Semon, Director, Health and Human Services Agency