Special Notice / Hearing: None__
Vote Required: Majority
To: Honorable Board of Supervisors
From: Colleen Chawla, Chief, San Mateo County Health
Michael del Rosario, Director, Correctional Health Services
Subject: Participation and Administrative Services Agreement with Department of Health Care Services for the Medi-Cal County Inmate Program
RECOMMENDATION:
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Adopt a resolution authorizing a participation and administrative services agreement with the State of California Department of Health Care Services for the Medi-Cal County Inmate Program for the term of July 1, 2026 to June 30, 2029.
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BACKGROUND:
In June 2014, this Board designated Correctional Health Services (CHS) as the entity to assist county jail inmates with their applications for health insurance affordability programs in accordance with Assembly Bill (AB) 720, Chapter 646, as part of California’s implementation of the Affordable Care Act. This effort was also implemented to leverage savings in preparation for the California Department of Health Care Services (DHCS) Medi-Cal County Inmate Program (MCIP), which constitutes the following two programs CHS participates in:
• The Adult County Inmate Program authorized in Welfare and Institutions Code section 14503.7, provides Medi-Cal coverage to eligible county inmates for inpatient hospital services provided off the grounds of correctional institutions.
• The Juvenile County Ward Program authorized in Welfare and Institutions Code section 14053.8, provides Medi-Cal coverage to eligible juvenile county wards for inpatient hospital and inpatient mental health services provided off the grounds of the correctional institutions.
On April 29, 2026, DHCS released the FY 2026-29 participation agreement (PA) and administrative services agreement (ASA) for counties choosing to voluntarily participate in the fee-for-service MCIP.
DISCUSSION:
Without voluntarily participating in the MCIP, CHS would be responsible for paying the cost of inmate medical care provided outside its correctional facilities. DHCS, as the state agency administering the MCIP, can draw federal funds for allowable services, such as inpatient hospital, psychiatric stays, and physician services during the inpatient stay.
CHS will refer completed Medi-Cal applications to the Human Services Agency to determine and code eligibility appropriately for MCIP-eligible status for any inmate requiring inpatient hospitalization. Non-contract Medi-Cal providers will directly bill DHCS for MCIP services, which DHCS will reimburse at the applicable Medi-Cal rate.
DHCS will then seek and retain federal financial participation claimed for MCIP services and the County will reimburse DHCS for the nonfederal share of claims paid by DHCS to the Medi-Cal provider for MCIP services. When the medical services are provided by a Designated Public Hospital (DPH), such as the San Mateo Medical Center (SMMC), the financial federal participation resulting from expenditures for the MCIP services will be claimed by the DPH under a certified public expenditure process. The County will also reimburse DHCS its annual apportioned share of the nonfederal share for administrative costs incurred for the MCIP as outlined in the ASA.
The PA, ASA, and resolution have been reviewed and approved by the County Attorney as to form.
It is anticipated that CHS will complete Medi-Cal applications for 100% of inmates requiring hospitalization.
PERFORMANCE MEASURE:
|
Measure |
FY 2025-26 Estimated |
FY 2026-27 Projected |
|
Percentage of inmates requiring hospitalization for whom CHS completes a Medi-Cal application |
100% 52 inmates |
100% 55 inmates |
COMMUNITY IMPACT:
Participation in DHCS MCIP will positively impact equitable health outcomes of incarcerated people who often are identifying or treating conditions not previously addressed. CHS patients span a wide spectrum of races, ethnicities, and gender. By linking them to Medi-Cal eligibility, they can continue care upon community reentry, improving community health outcomes.
FISCAL IMPACT:
The term of the PA and ASA is July 1, 2026, to June 30, 2029. Though there is no dollar amount associated with the PA, the cost reduction of $344,250 to CHS and increased reimbursement of $724,932 to SMMC are included in the CHS and SMMC FY 2026-27 Recommended Budgets. The MCIP total annual value of $1,069,182 from the cost reduction and increased reimbursement are based on FY 2024-25 MCIP billable charges from non-contract Medi-Cal providers and SMMC, representing approximately 52 inmates who received inpatient services.
CHS is responsible for DHCS’ annual administrative charge of 30% of the total administrative costs distributed evenly to participating counties exceeding 50,000 people in population and 70% of the total administrative costs allocated to participating counties pro rata based on population. Based on the latter formula, the DHCS maximum payable annual administrative amount shall not exceed $31,090.
Future cost reduction and increased reimbursement will vary depending on how many inmates are eligible for Medi-Cal and the level of care they require.
There is no Net County Cost associated with this PA and ASA.