Special Notice / Hearing: None__
Vote Required: 4/5th
To: Honorable Board of Supervisors, Acting as the Governing Board of the Public Authority
From: Colleen Chawla, Chief, San Mateo County Health
Lee Pullen, Director, Aging and Disability Services
Subject: Amendment to the Agreement with San Mateo Community Health Authority, dba Health Plan of San Mateo to Provide Health Benefits to Independent Providers of the In-Home Supportive Services Program
RECOMMENDATION:
title
Acting as the Governing Board of the Public Authority:
A) Adopt a resolution authorizing an amendment to the agreement with San Mateo Community Health Authority, dba Health Plan of San Mateo to provide health benefits to independent providers of the In-Home Supportive Services program, extending the term through December 31, 2026, and increasing the maximum amount payable by $11,000,000, to a total amount not to exceed $20,500,000; and
B) Approve an Appropriation Transfer Request (ATR) in the amount of $1,543,951 from unanticipated intergovernmental revenue to cover the projected increase in independent providers’ health premiums
body
BACKGROUND:
In 1993, the San Mateo County Board of Supervisors approved an ordinance establishing the Public Authority (PA) as the legal entity to administer the provider component of the In-Home Supportive Services (IHSS) program. The ordinance also designated the San Mateo County Board of Supervisors as the PA’s Governing Board. The mission of IHSS is to help eligible elderly, blind, and disabled individuals remain in their homes for as long as safely possible. Independent providers assist county residents with a wide variety of daily living activities, including bathing, eating, preparing meals, and performing certain paramedical services authorized by a physician.
The Service Employees International Union (SEIU) represents the IHSS independent providers in negotiations regarding issues such as wages and health, dental, and vision benefits. In January 2024, this Board adopted the current Memorandum of Understanding (MOU), pursuant to which the PA administers benefits, including health benefits, for IHSS providers.
In 2015, this Board approved an agreement with the Health Plan of San Mateo (HPSM) to provide health benefits through HealthWorx for IHSS providers. Subsequent amendments were executed over the years.
In January 2025, this Board authorized a new agreement with HPSM for HealthWorx benefits for the term of January 1, 2025, through December 31, 2025, in an amount not to exceed $9,500,000.
The County pays for health benefits through HealthWorx for covered IHSS providers pursuant to the terms of the MOU with SEIU.
DISCUSSION:
This agreement increases the current HealthWorx monthly premium to $689.55 per covered IHSS provider member. The total estimated cost of health care benefit premiums for the 1,300 IHSS providers on HealthWorx and for Consolidated Omnibus Budget Reconciliation Act (COBRA) participants for the 2026 calendar year is $10,756,980. As such, the maximum amount payable under this agreement is increased by $11,000,000 for the term of January 1, 2025, through December 31, 2026. The 1,300 slots have already been filled and currently there is a waitlist for them.
A waiver to the Request for Proposals process is requested from this Board to ensure continuous and uninterrupted health insurance benefits for IHSS providers and COBRA participants. The PA is working with SEIU to determine future needs for provider benefits and plans to have a new insurer in place by January 2027.
The resolution contains the County’s standard provisions allowing amendment of the fiscal obligations by a maximum of $25,000 (in aggregate).
The amendment and resolution have been reviewed and approved by the County Attorney’s Office as to form.
It is anticipated that 100% of the 1,300 available HealthWorx slots will be filled by eligible IHSS providers.
PERFORMANCE MEASURE:
|
Measure |
FY 2025-26 Estimated |
FY 2026-27 Projected |
|
Percentage of available HealthWorx slots filled by eligible IHSS providers |
100% 1,300 slots |
100% 1,300 slots |
COMMUNITY IMPACT:
This agreement will positively impact caregivers of the IHSS program by providing these individuals with health benefits. There are currently 9,094 caregivers who provide in-home care services through the IHSS program. There are 1,300 slots for HealthWorx benefits and 1,300 caregivers currently enrolled.
The California Department of Social Services (CDSS) manages caregiver enrollment and collects information about the providers’ primary written and spoken language. Per CDSS, the distribution for County caregivers is as follows: English (spoken 64%, written 67%), Spanish (spoken 14%, written 14%), Chinese languages (spoken 6%, written 6%), Tagalog (spoken 3%, written 3%), and Russian (spoken 3%, written 2%). HPSM offers a multilingual call center for caregivers. Applications for health benefits are currently available in English, Spanish, and Chinese. The PA plans to have the application translated into Tagalog and Russian as well.
FISCAL IMPACT:
The term of this amended agreement is from January 1, 2025 through December 31, 2026, and the maximum amount payable is $20,500,000. Funds for these services were included in the Aging and Disability Services FY 2025-26 Adopted Budget. Approval of the Appropriation Transfer Request (ATR) is needed to cover the increase for the term through December 2026. The ATR results in an increased appropriation of $1,543,951 to cover the independent providers’ premium increase. The cost of the premium increase will be covered entirely by State and federal reimbursements for health-related provider benefits. There is no Net County Cost associated with this agreement