Title
a. Approve and authorize the Director or designee of the Department of Social Services to sign Amendment #1 to Agreement #5010-378 with SolutionsWest for Medi-Cal Support Services to support processing Medi-Cal renewals and intakes, by adding $1,210,463 for a new contract amount of $2,864,678, extending the term by nine (9) months, for a new term of October 1, 2023 through June 30, 2025; and
b. Authorize the Director or designee of the Department of Social Services to sign up to three future amendments to this Agreement where the total amendments do not exceed 10% ($286,468) of the amended contract amount, do not significantly change the scope of work, and do not to exceed maximum of $3,151,146.
Report
RECOMMENDATION:
It is recommended that the Board of Supervisors:
a. Approve and authorize the Director or designee of the Department of Social Services to sign Amendment #1 to Agreement #5010-378 with SolutionsWest for Medi-Cal Support Services to support processing Medi-Cal renewals and intakes, by adding $1,210,463 for a new contract amount of $2,864,678, extending the term by nine (9) months, for a new term of October 1, 2023 through June 30, 2025; and
b. Authorize the Director or designee of the Department of Social Services to sign up to three future amendments to this Agreement where the total amendments do not exceed 10% ($286,468) of the amended contract amount, do not significantly change the scope of work, and do not to exceed maximum of $3,151,146.
SUMMARY/DISCUSSION:
Monterey County Department of Social Services (MCDSS) is responsible for renewing each Monterey Resident beneficiary enrolled in Medi-Cal annually. Due to the Public Health Emergency (PHE) during the COVID-19 pandemic (April 2020-April 2023), waivers were in place that allowed these annual renewals to be processed automatically. Beginning in May 2023, the waivers were removed, and manual renewals were again required. The MCDSS Community Benefits division is responsible for this effort. The Medi-Cal caseload is now higher than the average year during the PHE, and this along with Medi-Cal policy changes, seasonal demand for County services, and staffing changes presents resource challenges for MCDSS.
MCDSS will potentially be subject to newly enacted state benchmarks for all counties in 2025. Failure to meet these benchmarks can result in financial sanctions of 2% of the county’s base allocation for the subsequent fiscal year. These benchmarks will look at key indicators in Medical Eligibility Data System (MEDS). MEDS is statewide data hub for eligibility, enrollment and reporting functions for Medi-Cal and other state and federal benefits. MCDSS has been working diligently for the past 14 months to process new cases along with the assistance of an outside contract with SolutionsWest to complete new cases and Medi-Cal redeterminations per the California Department of Healthcare Services (DHCS) standards. Responding to the significant operational challenges associated with redetermining the eligibility of all Medi-Cal recipients while managing staff vacancies, increased Medi-Cal caseload from 2020 to 2023 of 13%, and the increase in demand for other services with Community Benefits requires assistance from a vendor that understands the Medi-Cal program and the State data systems. The SolutionsWest team that is processing cases do not have the added tasks that MCDSS staff have such as processing inboxes, answering customer calls, speaking with walk-in customers, or answering caseload emails. Without the added duties County staff encounter on average, the SolutionsWest staff can process upwards of 400 cases per week. The advantages of continuing to contract with Solutions West are: MCDSS will meet DHCS standards and avoid sanctions, processing renewals will lead to a reduction of walk-in cases allowing county staff more processing time and to be able to in 2025 reduce the amount of overtime paid to staff to process tasks. Working with SolutionsWest all also allow time to hire and train additional full-time MCDSS staff.
The contractor shall provide a Medi-Cal Support Services team consisting of 13 members, including 10 Support Specialists, 2 Supervisors, and 1 Project Manager. Solutions West is ideally suited to assist MCDSS, given their experience in similar projects, staff qualifications, and subject matter expertise. The contractor team has decades of experience providing client services for various programs such as Medi-Cal, CalFresh, CalWORKs, and General Assistance.
OTHER AGENCY INVOLVEMENT:
The Office of County Counsel has reviewed and approved the Agreements as to form, as has the Auditor-Controller’s Office as to financial provisions.
FINANCING:
This agreement is funded by the Medi-Cal allocation. Sufficient appropriations and estimated revenues for Social Services Fund 001, Appropriations Unit SOC005 are included in the FY 2024-25 Adopted Budget.
BOARD OF SUPERVISORS STRATEGIC INITIATIVES:
This amendment correlates to the Health and Human Services Strategic Initiative adopted by the Board of Supervisors by ensuring that Medi-Cal customers will experience a timely processing of their application for benefits and benefit renewals and avoid any unnecessary disruptions in benefit availability thereby helping to maintain the health and welfare of the community.
Check the related Board of Supervisors Strategic Initiatives:
__Economic Development
__Administration
X Health & Human Services
__Infrastructure
__ Public Safety
Prepared by: Joshua Eisenberg, Management Analyst II, x4411
Approved by: Lori A. Medina, Director, x4430
Attachments: Amendment No.1
Agreement
The proposed agreement is on file with the Clerk of the Board as an attachment to this Board Report.