Title
Consider authorizing and directing the Chief Executive Officer of Natividad Medical Center (NMC) and the Director of Health to request from the California Department of Healthcare Services (DHCS), by written notice, a modification of ViaCare, Monterey County's Low Income Health Program (LIHP), federal poverty level (FPL) eligibility standards from 0 - 100% to 0 - 133%, effective August 1, 2013. (ADDED VIA ADDENDUM)
Report
RECOMMENDATION:
It is recommended that the Board of Supervisors:
Authorize and direct the Chief Executive Officer of Natividad Medical Center and the Director of Health to request from the California Department of Healthcare Services, by written notice, a modification of ViaCare, Monterey County's Low Income Health Program (LIHP), federal poverty level (FPL) eligibility standards from 0 - 100% to 0 - 133%, effective August 1, 2013.
SUMMARY:
On March 4, 2013, Monterey County launched ViaCare, the County's LIHP as part of a statewide effort to sustain and strengthen the MediCal (California's Medicaid) program. ViaCare is a partnership between Natividad Medical Center, the Monterey County Health Department, and the Monterey County Department of Social Services. As of June 7, 2013, 1061 applications have been received, averaging 70 applications per week over the past fourteen weeks. 735 individuals have been approved with an approximately 18 % denial rate primarily due to income levels. The program expenditures have averaged around $300,000 per month based on claims processed and paid for the past two months. Half of the cost was spent on behavioral services, 25% on hospital services, 5% on physicians and the remaining on administrative and program support. Program costs will likely increase over the next few months as the program and membership becomes better established. An increased FPL will result in a projected increase of applications by 25%. This increase will translate to expanded health coverage to uninsured adults with high quality, coordinated, efficient health care services and will aide in the seamless transition of this population into MediCal as part of healthcare reform implementation 1/1/14.
OTHER AGENCY INVOLVEMENT:
NMC, the Monterey County Health Department, Department of Social Services, County Administrative Office, County Counsel, and the Auditor-Controller's Office were involved in this recommended action.
FINANCING:
All ViaCare expenditures are included in the FY 2013 Adopted Budget and the FY2014 Recommended Budget. The County may establish enrollment caps and make adjustments to the ViaCare income eligibility to avoid exceeding the available funding following DHCS rules regarding those matters.
Approved by:
______________________ ____________ __________________ ____________
Harry Weis, Date Ray Bullick, Date
NMC CEO Monterey County Director of Health