Title
a. Approve and Authorize the Director of Health to implement a Pilot Project for the Remaining Uninsured to cover the cost of specified pharmacy, laboratory, and radiology services for Monterey County eligible uninsured residents;
b. Authorize the Director of Health to establish the list of specified covered pharmacy, laboratory and radiology services;
c. Authorize $500,000 of General Fund Contingency to fund the Pilot Project for the Remaining Uninsured to cover the cost of the specified pharmacy, laboratory and radiology services;
d. Authorize the Auditor-Controller to amend the FY 2015-16 Health Department 001-4000-HEA007-8096 Adopted Budget to increase the appropriation and General Fund Contribution by $500,000, (4/5ths vote required); and
e. Approve and authorize the Auditor-Controller to transfer $500,000 from CAO-General Fund Contingencies 001-1050-CAO020-8034 to the Health Department 001-4000-HEA005-8096 (4/5ths vote required).
Report
RECOMMENDATION:
It is recommended that the Board of Supervisors:
a. Approve and Authorize the Director of Health to implement a Pilot Project for the Remaining Uninsured to cover the cost of specified pharmacy, laboratory, and radiology services for Monterey County eligible uninsured residents; and
b. Authorize the Director of Health to establish the list of specified covered pharmacy, laboratory and radiology services; and
c. Authorize $500,000 of General Fund Contingency to fund the Pilot Project for the Remaining Uninsured to cover the cost of the specified pharmacy, laboratory and radiology services; and
d. Authorize the Auditor-Controller to amend the FY 2015-16 Health Department 001-4000-HEA007-8096 Adopted Budget to increase the appropriation and General Fund Contribution by $500,000, (4/5ths vote required); and
e. Approve and authorize the Auditor-Controller to transfer $500,000 from CAO-General Fund Contingencies 001-1050-CAO020-8034 to the Health Department 001-4000-HEA005-8096 (4/5ths vote required).
SUMMARY/DISCUSSION:
Approximately 30,000 - 50,000 residents of Monterey County remain uninsured and ineligible for health insurance coverage under the Affordable Care Act. Although the Federally Qualified Health Centers and others provide primary and specialty care services for these residents, there
frequently is no funding for the cost of pharmacy, laboratory or radiology services. As a result, people often cannot afford to follow the recommendations and referrals of physicians and so remain untreated. This often leads to people become increasingly ill and they then require more costly hospital and/or emergency room care.
This concern was raised to Health Department staff by Communities Organized for Power in Action (COPA), and after discussion and analysis of the situation, Health Department staff, in collaboration with Natividad Medical Center (NMC) and COPA, developed a Pilot Project for the Remaining Uninsured. Under the Pilot, the County of Monterey will allocate $500,000 of general fund dollars to cover the cost of specified pharmacy, laboratory and radiology services. The Pilot will enable qualified uninsured County residents to see providers in the Monterey County Health Department Clinics as is current practice, and when the Clinic providers recommend these specified diagnostic services, and pharmacy services, this funding will cover those costs. This will help enable patients to comply with medical recommendations and to access diagnosis and treatment services. With earlier diagnosis and immediate pharmacological treatment, it is anticipated that health outcomes will improve and, secondarily, that the cost of care will be reduced, as unnecessary Emergency Department visits and hospitalizations will be avoided.
If approved by the Board of Supervisors, it is anticipated that the Pilot Project will begin in October 2015 and end when the funds allocated to the project have been fully expended. County clinical staff developed a pharmacy formulary and a list of eligible laboratory and radiology services for reimbursement, designed to best address the medical needs of this population. The Pilot Project will be limited to a closed provider network, with medical care delivered at County Health Department and Natividad Medical Center Clinics. Laboratory and radiology services will be through Natividad Medical Center under a Memorandum of Agreement with the Health Department specifying the cost of services. Patients will be able to access the specified Walgreens locations in Monterey County. The County has a 340B discount drug program contract pharmacy agreement with Walgreens, allowing the County Federally Qualified Health Care Lookalike sites to purchase prescription pharmaceutical drugs for eligible patients at a discounted price.
The Department of Social Services will provide eligibility services and, when appropriate, eligible Pilot Project participants will be enrolled in limited scope Medi-Cal. Monterey County Health Department staff will support this effort by explaining the specifics of the Pilot Project to eligible individuals and providing informed consent forms during their visit to the County Clinic. Participating patients will be notified that the pilot project is entirely voluntary and that they may withdraw at any time. Participating patients will also be notified that the pilot is not permanent and that the program will end when the designated funds are spent.
The services being offered through the pilot program frequently act as a barrier to care as patients are unable to afford them, often leading to acute illness resulting in a higher cost of care. The County intends to use this Pilot Project to evaluate the benefits of offering access to these services to eligible uninsured County residents. The goal is that the Pilot Project will improve the health of uninsured County residents by helping them get needed medical tests and treatments.
Throughout the Pilot staff will track cost of care per patient and clinical outcomes indicators, comparing Limited Scope Medi-Cal and Pilot Project data. At the end of the Pilot, this data will be analyzed and a report will be presented to the Board of Supervisors.
The Health Department recently applied for grant funding from the Blue Shield of California Foundation “Moving Toward Comprehensive Coverage Programs for the Remaining Uninsured”. Should this proposal be awarded, the Health Department will return to the Board of Supervisors for approval. Part of this award will be used to offset expenses incurred for administration of this project.
OTHER AGENCY INVOLVEMENT:
County Counsel, Department of Social Services, CAO budget office and Natividad Medical Center have been involved in development of this Pilot Project.
FINANCING:
The Health Department is requesting an amendment to its FY 2015-16 Health Department 001-4000-HEA007-8096 Adopted Budget to increase the appropriation and General Fund Contribution by $500,000, funded by General Fund Contingency.
The Adopted FY 2015-16 General Fund Contingencies appropriation is $5,399,351. Approved transfers from General Fund Contingencies thus far total $852,406, leaving a balance of $4,546,945. The County Administrative Office is aware of a number of other needs/requests for use of the contingency appropriations, including: funding for the September 8, 2015 jail class action settlement agreement, the Interlake tunnel project, cash match for the SB 863 grant (mental health and vocational program facility construction), and various other requests. The Contingencies appropriation does not have sufficient remaining funding to cover all known requests.
Prepared By: Stephanie Shonley, Management Analyst, 1313
Approved By: Ray Bullick, Director of Health, 4526