Title
a. Receive a presentation on the Affordable Care Act and potential impact to Monterey County’s Natividad Medical Center and Health Department if repealed; and
b. Receive a presentation on Monterey County’ Pilot Project for the Remaining Uninsured; and
c. Receive recommendations from the Ad Hoc Committee for continuation of Monterey County’s Pilot Project for remaining uninsured; and
d. Provide direction to staff regarding next steps.
Report
RECOMMENDATION:
It is recommended that the Board of Supervisors:
a. Receive a presentation on the Affordable Care Act and potential impact to Monterey County’s Natividad Medical Center and Health Department if repealed; and
b. Receive a presentation on Monterey County’ Pilot Project for the Remaining Uninsured; and
c. Receive recommendations from the Ad Hoc Committee continuation of Monterey County’s Pilot Project for remaining uninsured; and
d. Provide direction to staff regarding next steps.
SUMMARY/DISCUSSION:
The Affordable Care (ACA) was enacted to provide Medicaid (Medi-Cal) and other coverage options through the exchange to many low-income individuals with the goal of decreasing the number of uninsured individuals. However, many Monterey County residents remain uninsured and unable to pay for costly medical care, procedures and prescription medications. Of those uninsured, it is estimated that there are approximately 30,000 to 50,000 residents without any medical insurance living in Monterey County due to their documentation status. In order to address similar uninsured gaps state-wide, the Governor and the State Legislature agreed upon a Budget that funds full scope Medi-Cal coverage for eligible undocumented California residents from age 0 - 19 which took effect May 2016. In Monterey County about 6,000 children were enrolled in managed Medi-Cal at that time still leaving many uninsured individuals in the County.
In response to this need, the Board of Supervisors approved an allocation of $500,000 of General Fund dollars in August 2016 establishing the County’s Pilot Project for the Remaining Uninsured to provide limited scope pharmaceuticals, laboratory tests, and radiology services as presented by staff in collaboration with COPA (Communities Organized for Relational Power and Action). These services are provided by the Health Department’s Federally Qualified look-alike health clinics which are mandated, by HRSA (Health Resources and Services Administration), to provide medical care to all patients regardless of ability to pay and by Natividad Medical Center (NMC). The County’s Pilot Project for the Remaining Uninsured was implemented in November 2015 and through February 2017 has served almost 1,900 individuals. The presentation will highlight client demographics, services provided, and costs to date.
At the Board of Supervisor’s meeting on October 18, 2016, an Ad Hoc committee to further explore opportunities for the provision of healthcare services to the Remaining Uninsured was created. This Ad Hoc Committee has met several times and drafted recommendations for the Board’s consideration to continue and expand services to the Remaining Uninsured. The Ad Hoc Committee has three recommendations:
• Option 1 - Full scope primary care which will provide a full array of County operated primary care services including laboratory, diagnostic imaging, and limited generic drugs. This array of services is estimated to be $936,000 per year for 1,000 individuals.
• Option 2 - Full scope primary care and ambulatory specialty services which would provide services outlined for Option 1 plus NMC based outpatient specialty services. This array of services is estimated to be $1.8 million for 1,000 individuals.
• Option 3 - ViaCare 2.0, Central California Alliance for Health (CCAH) administered Medi-Cal like plan. This array of services is estimated to be $21 million for 5,000 individuals.
The presentation will include additional details regarding these three options and recommendations from the Ad Hoc Committee. Staff seek direction from staff regarding next steps for providing services to Remaining Uninsured.
In addition to providing an update on the Pilot Project and recommendations from the Ad Hoc Committee, staff will also provide a brief update on the Affordable Care Act and potential impacts to Monterey County’s Natividad Medical Center and Health Department if it is repealed. With the passage of the ACA, an additional 33,000 Monterey County resident are enrolled in managed care Medi-Cal administered by CCAH through the expansion resulting in an additional $128 million in Medi-Cal funding to Monterey County. If the Medi-Cal expansion and Covered California are repealed, Natividad Medical Center and the Health Department could face an estimated reduction in revenue up to $38 million and $7 million per year, respectively.
OTHER AGENCY INVOLVEMENT:
Natividad Medical Center and the Health Department prepared the report and presentation. The Board of Supervisor’s Ad Hoc Committee comprised of County staff, COPA, the Center for Community Advocacy, Community First Coalition and other community stakeholders were involved in the development of recommendations for continuation of coverage for remaining uninsured.
FINANCING:
The staff report outlines three recommendations for consideration by the Board of Supervisors for continuation and potential expansion of services to the County’s remaining uninsured. The anticipate costs per year range from approximately $1 million to cover 1,000 individuals for primary care services and ancillary services to $26 million to serve 5,000 individuals for full scope Medi-Cal like services. General Fund dollars would need to be secured to fund implementation of any continuation or expansion of current services provided to the remaining uninsured.
The expenditures from November 2015 to December 2017 for the current Pilot Project scope of services is approximately $150,000. Health Department and Natividad Medical Center are working closely to finalize costs to date.
Prepared by and Approved by: Elsa Jimenez, Director of Health, 4526
Gary Gray, DO, NMC CEO