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Health and Human Services Agency (HHSA) recommending the Board approve and authorize the HHSA Director, or Director of Public Health to sign the Letter of Intent with the Health Plan of San Joaquin for mutual intent to negotiate and develop a Medical Services Agreement.
FUNDING: N/A
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DISCUSSION / BACKGROUND:
California’s Medicaid program, Medi-Cal, is the largest state Medicaid program in the nation. Insuring almost one-third of California’s residents, Medi-Cal is a key source of 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 health care plan for people receiving Medi-Cal. Through this managed health care plan, referred to as the Health Plan of San Joaquin (HPSJ) Local Initiative 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) that has been providing healthcare services to the Central Valley community for over two decades. It is publicly sponsored and collaborates with the Medi-Cal Managed Care Division of the DHCS to deliver healthcare to Medi-Cal members. HPSJ prioritizes primary and preventive care through organized systems of care networks, aiming to provide quality healthcare, improve accessibility, and reduce costs.
Beginning in 2021, the DHCS began expanding the Commission’s managed health care plan to rural counties, to allow participating counties to have greater local influence and control over their managed care medical system. On August 31, 2021, the County of El Dorado (County) Board of Supervisors (Board) approved in concept to transition the County to the HPSJ Managed Care Plan Model (21-1362). Subsequently, on December 14, 2021, the Board adopted Ordinance No. 5149, which authorized the County to join the Commission (21-1422).
Starting January 1, 2024, HPSJ will expand its coverage as a Medi-Cal health plan to include El Dorado and Alpine Counties. This item presented to the Board is to authorize the signing of a non-binding Letter of Intent with the Health Plan of San Joaquin, which will confirm the County’s mutual intent to facilitate negotiations and enable the development of a Medi-Cal Services Agreement for the HPSJ Managed Care Model. SPSJ’s initial intent was for the County and SPSJ to execute the resulting Medical Services Agreement by the first of quarter of 2023. However, due to HHSA wanting to receive the Board’s approval of this letter, this agreement has been postponed in order to allow HHSA to receive Board approval. Upon issuance of the resulting HPSJ Medi-Cal Services Agreement, HHSA will bring said agreement to the Board for acceptance.
ALTERNATIVES:
Should the Board decline to approve this recommendation, the County of El Dorado will lose the opportunity to partner with the Health Plan of San Joaquin to improve 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
OTHER DEPARTMENT / AGENCY INVOLVEMENT:
Approved by County Counsel.
CAO RECOMMENDATION:
Approve as recommended.
FINANCIAL IMPACT:
There is no financial impact associated with this Letter of Intent.
CLERK OF THE BOARD FOLLOW UP ACTIONS:
N/A
STRATEGIC PLAN COMPONENT:
Healthy Communities
CONTACT
Olivia Byron-Cooper, MPH, Interim Director, Health and Human Services Agency