Special Notice / Hearing: None__
Vote Required: Majority
To: Honorable Board of Supervisors
From: Louise F. Rogers, Chief, San Mateo County Health
Marc Meulman, Director, Public Health, Policy and Planning
Subject: Amendment to the Memorandum of Agreement with the San Mateo County Health Commission Regarding the Whole Person Care Pilot Program and Measure K Funds
RECOMMENDATION:
title
Measure K: Adopt a resolution authorizing a fifth amendment to the memorandum of agreement between the County of San Mateo and the San Mateo County Health Commission regarding the Housing Program implemented as part of the Whole Person Care Pilot, increasing the amount payable by $6,000,000 to an amount not to exceed $36,333,453 and extending the agreement term by three years to June 30, 2025.
body
BACKGROUND:
Whole Person Care (WPC) was a pilot program funded under the five-year renewal of California’s Section 1115 Medicaid Waiver (Medi-Cal 2020). San Mateo County Health (SMCH) implemented the WPC pilot to provide a coordinated, efficient, and effective delivery of medical, behavioral health, and social services to the County’s highest-risk and vulnerable populations. Through an agreement with the California Department of Health Care Services (DHCS), SMCH received up to $16,536,771 in new revenue annually, with funds rolling over from year to year, as needed, for WPC services for the period January 1, 2017 through December 2020.
As part of the Whole Person Care Pilot your Board approved the allocation of Measure K funds - $1,000,000 in FY 2016-17 and $2,000,000 per fiscal year thereafter for WPC client housing services for the term of the pilot. Housing services would not have been funded otherwise through the DHCS agreement. On June 6, 2017, this Board approved Resolution 075225, as amended by Resolution 077133, approving a Memorandum of Agreement (MOA) between the County of San Mateo and the Health Plan of San Mateo (HPSM) to enhance the Community Care Setting Pilot (CCSP) and implement Measure K housing services for SMCH clients for the term of the WPC pilot.
The MOA between SMCH and HPSM was amended on March 6, 2018 to incorporate the scope of work inadvertently labeled as Section One, to add the WPC Care Coordination Policy and Approach inadvertently labeled as Section Two, and to add WPC and Measure K Payment Plan inadvertently labeled as Section Three.
On December 10, 2019, the Board of Supervisors approved Resolution 077133, which approved an amendment to the MOA that further amended the scope of work inadvertently labeled as Section One, to include recuperative care start-up costs, add required reports inadvertently labeled as Section Two, and to amend the payment plan inadvertently labeled as Section Three.
On March 9, 2021, the MOA was further amended to extend the term through June 30, 2022, due to the extension of the Whole Person Care Pilot, clarify the deadlines for required reports in section 3(b), add Section 2(f) to increase the fiscal obligation by $5,992,990 from $24,340,463 to $30,333,453, amend the scope of work now properly labeling it as Exhibit A, amend the payment plan to include recuperative care services properly labeling it as Exhibit B, include WPC and Measure K Payment Plan in Exhibit B, and properly label the WPC Care Coordination policy and approach as Exhibit C.
On January 3, 2022, the MOA was amended a fourth time to replace Exhibit A with Exhibit Al to reallocate $300,000 in Measure K funds from Housing Services to the Vision to Learn program. These funds supplement the HPSM vision provider network to create additional access to vision care for up to 3,000 Medi-Cal beneficiaries in the twelve San Mateo County school districts.
DISCUSSION:
HPSM was an integral partner in the Whole Person Care Pilot, providing services through contracts with community-based organizations for the Community Care Settings Pilot, funded by the pilot, and the Housing Service Program, funded through Measure K dollars. While the Whole Person Care Pilot ends on June 30, 2022, this amendment seeks to continue the Housing Services program under the MOA with HPSM.
Since late 2017, the Housing Services Program utilized one million dollars of Measure K funds annually to provide permanent housing to more than 100 individuals who experienced chronic homelessness and who have complex medical and behavioral health challenges. Several strategies were used to achieve this outcome including direct rental subsidies, location services, including leveraging various Housing Authority Vouchers, and housing retention services. Currently, two million dollars in Measure K funds support 50 formerly homeless individuals through direct rental subsidies and housing retention services. This budget also allows the HPSM, through a housing community base organization, to provide housing location services for new referrals.
Under this amendment, $250,000 will be re-allocated from Measure K savings to partially fund the Orthodontia Access Pilot (OAP). This is a new program designed to increase community access to orthodontia care within the Medi-Cal Dental program in San Mateo County. San Mateo County residents between the ages of twelve to twenty-three who meet eligibility criteria will be identified by dentists and referred to HPSM, who will then refer them to participating orthodontists for treatment not covered by the Medi-Cal Dental program. HPSM will aim to engage in treatment one hundred (100) eligible patients with participating orthodontists during each year of the pilot.
Under this amendment, the MOA term will be extended to June 30, 2025, Exhibit A1 will be replaced with Exhibit A2, $250,000 in Measure K savings will be reallocated to the new OAP program, Exhibit B and Exhibit C will be removed, and the fiscal obligation will be increased by $6,000,000 from $30,333,453 to $36,333,453.
The agreement and resolution have been reviewed and approved by County Attorney as to form.
The resolution contains the County’s standard provisions allowing amendment of the County fiscal obligations by a maximum of $25,000 (in aggregate).
It is anticipated that one hundred (100) eligible patients will engage in treatment with participating orthodontics during each cohort year with 90% completing treatment.
It is anticipated that at least 50 individuals will receive a direct rental subsidy annually and that 90% of recipients, who do not require a higher level of care, will maintain their housing.
PERFORMANCE MEASURES:
FISCAL IMPACT:
The term of the amended MOA is July 1, 2022 through June 30, 2025. The amount of the agreement is not to exceed $6,000,000 in Measure K funds. Funds in the amount of $2,000,000 will be included in the Public Health, Policy and Planning budget for each fiscal year 2022-23, 2023-24 and 2024-25.