Special Notice / Hearing: None__
Vote Required: Majority
To: Honorable Board of Supervisors
From: Supervisor Ray Mueller, District 3
Subject: Direction to San Mateo County Health to Accept Private Health Insurance at the Coastside Clinic
RECOMMENDATION:
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Adopt a resolution directing San Mateo County Health, in consultation with the County Executive's Office, County Attorney, and other appropriate County departments, to within 90 days prepare an implementation roadmap to:
A) Enable the Coastside Health Center to contract with and accept commercial health insurance plans, including potential partnerships with private healthcare providers, while maintaining access for Medi-Cal, Medicare, uninsured, and underinsured patients; and
B) Provide for a local laboratory specimen collection program accessible to Coastside residents regardless of insurance type, including patients whose treating clinicians practice outside the County health system.
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BACKGROUND:
Reliable, timely access to healthcare and laboratory services remains a significant concern for Coastside residents. Many residents currently must travel to the Bayside for routine blood draws, diagnostic testing, medication-related laboratory monitoring, follow-up appointments, and other healthcare services.
This travel requirement creates a substantial access barrier, particularly for older adults, persons with disabilities, residents without personal vehicles, and individuals who rely on public transit, paratransit, shuttle services, family members, or caregivers for transportation. Traffic congestion and weather-related conditions on Highways 1, 92, and 84 may further delay or prevent access to necessary medical services. These barriers can be particularly consequential for individuals managing chronic medical conditions, including diabetes, hypertension, cardiovascular disease, kidney disease, thyroid disorders, anticoagulation needs, and other conditions requiring periodic laboratory monitoring to guide treatment decisions and support safe medication prescribing, continuation, or adjustment.
The County has taken important steps to improve local healthcare access. In 2024, the County funded a urgent healthcare pilot in Half Moon Bay following the closure of the Seton Coast emergency room (Pilot). The Pilot operated from October 30, 2024, through April 14, 2025, with appointments continuing through June 2025.
The Pilot served Coastside residents, visitors requiring urgent care, and patients across insurance statuses, including uninsured and underinsured patients, none of whom were required to meet Dignity Health patient eligibility criteria. The Pilot recorded 1,638 appointments, and Coastside residents represented 82% (1,338) of patients served. Importantly, usage of the pilot services increased over this. Patients were treated for a range of common clinical conditions, including upper respiratory infections, musculoskeletal strains and sprains, rashes, hypertension and diabetes management.
The Pilot’s payer mix consisted primarily commercial insurance, including Blue Cross, Blue Shield, Aetna, and UnitedHealthcare, followed by the Health Plan of San Mateo, Medicare, and Kaiser. This experience indicates that a meaningful portion of Coastside residents seeking timely local care are covered by private insurance and may be unable to use County-operated services unless their health plan is accepted.
The Pilot also underscored the importance of clear clinical pathways when patients require emergency, trauma, specialty, or other higher-acuity services that cannot be safely or appropriately provided in an urgent-care or outpatient clinic setting.
Community feedback indicates an ongoing need for accessible local medical examinations, preventive care, regular checkups, bloodwork, and other routine laboratory testing.
For many patients, timely laboratory testing is medically necessary to monitor disease progression, identify complications, assess treatment effectiveness, support preventive care, and safely prescribe, renew, or adjust medications. Delayed or missed testing may contribute to avoidable gaps in care, delayed clinical decision-making, unnecessary urgent-care or emergency-department utilization, and poorer health outcomes.
Recent discussions concerning private-sector laboratory access on the Coastside have not provided sufficient assurance that dependable and sustained laboratory services will be available locally.
On September 23, 2026, the Midcoast Community Council submitted a letter supporting expanded acceptance of commercial insurance at the Coastside Health Center. (A copy of the letter is attached to this memorandum and incorporated by this reference.) The letter noted that expanding the Health Center's payer options could improve local health care access, reduce transportation barriers, and provide greater flexibility for Coastside residents seeking timely, in-network care.
DISCUSSION:
The proposed resolution directs San Mateo County Health, in consultation with the County Executive's Office, County Attorney, and other appropriate County departments, to within 90 days prepare an implementation roadmap to:
1. Enable the Coastside Health Center to contract with and accept commercial health insurance plans, including potential partnerships with private healthcare providers, while maintaining access for Medi-Cal, Medicare, uninsured, and underinsured patients; and
2. Provide for a local laboratory specimen collection program accessible to Coastside residents regardless of insurance type, including patients whose treating clinicians practice outside the County health system.
The roadmap should, at minimum:
• Provide the operational, clinical, financial, and legal framework for expanding commercial insurance participation at the Coastside Health Center, including potential contracting or partnerships, and of establishing local laboratory specimen collection and related laboratory access
• Identify a responsible approach to improving access to primary and preventive health care, chronic disease monitoring, diagnostic testing, and laboratory services for Coastside residents; and
• Identify the Coastside Health Center's current commercial payer participation, billing arrangements, patient eligibility requirements, and gaps in in-network access; and
• Identify at least one feasible near-term laboratory access option, the responsible implementing entity, estimated start-up and ongoing costs, required approvals, anticipated implementation timeline, and any actions requiring subsequent Board authorization; and, if no option is currently feasible, the roadmap shall identify the specific barriers and steps necessary to resolve them; and
• Outline how implementation can be achieved without diminishing existing services, appointment availability, or financial assistance for Medi-Cal, Medicare, uninsured, and underinsured patients, including applicable Health Center Program requirements.
COMMUNITY IMPACT:
Improving Coastside access to routine healthcare and laboratory services could reduce avoidable travel across the County, lessen transportation burdens, promote continuity of care, and support earlier clinical intervention for residents who require regular testing, monitoring, or follow-up.
The potential benefits are especially significant for older adults, persons with disabilities, residents with chronic medical needs, individuals without reliable transportation, and patients who depend on family members, caregivers, public transit, paratransit, or shuttle services. Improved access to local laboratory services is necessary to assist patients in completing recommended monitoring for chronic conditions, receive timely medication management, and maintain regular engagement with their healthcare providers.
Expanded commercial insurance participation at the Coastside Health Center will materially expand access for residents with commercial coverage and reduce delays associated with seeking in-network care outside the Coastside. A local in-network option will also help to improve access to preventive services, non-emergency medical evaluation, chronic disease management, laboratory testing, and follow-up care.
FISCAL IMPACT:
None.