Special Notice / Hearing: None__
Vote Required: Majority
To: Honorable Board of Supervisors
From: Louise F. Rogers, Chief, San Mateo County Health
Gina Wilson, Chief Financial Officer, San Mateo County Health
Chester Kunnappilly, MD, Chief Executive Officer, San Mateo Medical Center
Subject: Agreement with the San Mateo Health Commission
RECOMMENDATION:
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Adopt a resolution authorizing an agreement with the San Mateo Health Commission dba Health Plan of San Mateo for services to Medi-Cal members, for the term of January 1, 2022, through December 31, 2022, funded through Intergovernmental Transfers.
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BACKGROUND:
The County of San Mateo has contracted with the San Mateo Health Commission dba Health Plan of San Mateo (HPSM) since January 1994. The Board has approved numerous agreements and amendments for the provision of healthcare and behavioral healthcare services to HPSM members, including those enrolled in the Medi-Cal program. The Board has also approved prior agreements and amendments related to Intergovernmental Transfers (IGTs), a federally approved mechanism whereby County funds are provided to the State to draw down matching federal dollars for the Medi-Cal program. The County has long used IGTs to help pay for health services.
The original agreement for this purpose was executed in 2017 and amended ten times, extending the term through December 21, 2024, covering IGT agreements with the State from FY 2015 through calendar year 2021. The State process for sending drafts and making agreements generally runs behind approximately 2 years due to the reconciliation process of the enrollee information needed for the payment calculations.
DISCUSSION:
Due to the duration and many amendments of the prior agreements, a new agreement has now been developed. This agreement, which starts with calendar year 2022, allows HPSM to provide supplemental payments to County Health through the IGT to support the provision of services to HPSM’s Medi-Cal members. This agreement is starting with the calendar year 2022. This process requires County Health to contract with the State and then contract with the HPSM. The HPSM agreements are not completed until the State document is fully executed, which occurred in December 2023.
In exchange, County Health is required to remain a participating provider in HPSM and maintain services such as emergency room licensure, inpatient surgery suites, treatment for mental health and substance use disorders, and community-based services. The agreement terms also require that IGT revenues are used to fund health services and not returned to the County General Fund.
The agreement and resolution have been reviewed and approved by County Attorney as to form.
It is anticipated that 47,000 Medi-Cal recipients will be enrolled with San Mateo Medical Center (SMMC).
PERFORMANCE MEASURE:
|
Measure |
FY 2022-23 Actual |
FY 2023-24 Estimate |
|
Number of Medi-Cal recipients enrolled with SMMC at the end of the fiscal year |
41,500 Medi-Cal recipients |
47,000 Medi-Cal recipients |
EQUITY IMPACT
This agreement will positively impact equitable health outcomes by providing funding to SMMC, a public safety net hospital. Specifically, in the past 12 months, 68.3% of SMMC’s patients were enrolled in Medi-Cal with an additional 6.1% of SMMC’s patients enrolled in the “Access to Care for Everyone” (ACE) program. SMMC’s patients span a wide spectrum of races, ethnicities, gender, and gender-identities.
FISCAL IMPACT:
The term of the agreement is from January 1, 2022, to December 31, 2022. The current IGT for calendar year 2022 is $10,025,000, resulting in net new revenue of $15,500,000 and was included in the FY 2021-22 and FY 2022-23 budgets. Future IGTS will be included in the San Mateo Medical Center’s budget as appropriate through the budget processes.