Special Notice / Hearing: None__
Vote Required: 4/5ths
To: Honorable Board of Supervisors, Acting as the Governing Board of the Public Authority
From: Louise F. Rogers, Chief, San Mateo County Health
Lee Pullen, Director, Aging and Adult Services
Subject: Agreement with San Mateo Community Health Authority, dba Health Plan of San Mateo
RECOMMENDATION:
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Acting as the Governing Board of the Public Authority:
A) Adopt a resolution authorizing an 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 for the term of January 1, 2025, through December 31, 2025, in an amount not to exceed $9,500,000; and
B) Authorizing an Appropriation Transfer Request (ATR) in the amount of $1,338,341 from unanticipated intergovernmental revenue to cover the projected increase in independent providers’ health premiums.
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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 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 2021, the Board adopted the current Memorandum of Understanding (MOU), pursuant to which the PA administers benefits, including health benefits, for IHSS providers.
In 2001, the Board approved an agreement with the Health Plan of San Mateo (HPSM) to provide health benefits through HealthWorx for IHSS providers.
In June 2015, the Board authorized an agreement with HPSM for HealthWorx benefits for the term of July 1, 2015 through June 30, 2016, in an amount not to exceed $3,000,000. The Board approved further amendments from 2016 through 2024, extending the term and increasing the maximum amount payable. The most recent amendment extended the term of the agreement through December 31, 2024, and increased the maximum amount payable by $8,000,000, for a total amount not to exceed $49,000,000.
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 $599.61 per covered IHSS provider member. The total estimated cost of health care benefit premiums for the 1,300 IHSS providers on HealthWorx and for COBRA participants for the 2025 calendar year is $9,353,916. As such, the maximum amount payable under this agreement is $9,500,000 for the term of January 1, 2025 through December 31, 2025.
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. AAS is working with SEIU to determine future needs for provider benefits. Once the needs are determined, AAS will engage in an RFP process to ensure fairness and competitiveness for this agreement.
This agreement is coming to this Board late due to the vendor needing more time to prepare the new agreement.
The resolution contains the County’s standard provisions allowing amendment of the fiscal obligations by a maximum of $25,000 (in aggregate).
The agreement and resolution have been reviewed and approved by the County Attorney’s Office as to form.
It is anticipated that 100% or 1,300 slots of available HealthWorx slots will be filled by eligible IHSS providers.
PERFORMANCE MEASURE:
|
Measure |
FY 2024-25 Estimated |
FY 2025-26 Projected |
|
Percentage of available HealthWorx slots filled by eligible IHSS providers |
100% 1,300 slots |
100% 1,300 slots |
EQUITY IMPACT:
This contract will positively impact caregivers of the IHSS program by providing these individuals with health benefits. There are currently 8,268 caregivers who provide in-home care services through the IHSS program. There are 1,300 slots allotted toward this benefit and 1,263 caregivers are currently enrolled. Based on current caseload growth, we anticipate filling all slots within the first three months of 2025.
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%), 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 Public Authority will have the application translated into Tagalog and Russian by December 31, 2024.
FISCAL IMPACT:
The term of this agreement is from January 1, 2015 through December 31, 2025, and the maximum amount payable is $9,500,000. Funds for these services were included in the Aging and Adult Services FY 2024-25 Adopted Budget. Approval of the ATR is needed to cover the increase for the term through December 2025. The ATR results in an increased appropriation of $1,338,341 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.