Title
a. Receive an update on Monterey County’s, Esperanza Care Pilot Project for the Remaining Uninsured; and
b. Provide direction to staff concerning the enrollment cap.
Report
RECOMMENDATION:
It is recommended that the Board of Supervisors:
a. Receive an update on Monterey County’s, Esperanza Care Pilot Project for the Remaining Uninsured; and
b. Provide direction to staff concerning the enrollment cap.
SUMMARY/DISCUSSION:
The Affordable Care Act (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 response to this need, the Board of Supervisors approved an allocation of $500,000 of General Fund dollars 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). The services were provided by Natividad Medical Center (NMC) and 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. The Pilot Project was in effect from November 2015 through September 2017 and served over 2,000 individuals.
In May 2017, the Board of Supervisors directed staff to expand the program to full scope primary care and ambulatory specialty services, including laboratory, diagnostic imaging and limited generic drugs with a budget of $1.8 million for 2,500 individuals funded by NMC’s enterprise fund. In June 2017, the Board of Supervisors authorized an agreement with Pacific Health Alliance (PHA) to be the Third Party Administrator for the project. The PHA contract was executed on August 1, 2017. In conjunction with COPA, processes, forms, enrollment, staff education and community outreach were developed. The project, named Esperanza Care Monterey County, was fully operational on October 1, 2017. Enrollment into the project climbed steadily each month, reaching the full capacity of 2,500 individuals on February 9, 2018. A waiting list has been established and maintained by PHA.
Pacific Health Alliance will provide enrollment, demographic and financial reports.
OTHER AGENCY INVOLVEMENT:
The CAO-Office of Community Engagement & Strategic Advocacy, Natividad Medical Center and the Health Department prepared this report.
FINANCING:
Project funding in the amount of $2.0 million is included in NMC’s operational revenues residing in fund 451 for Fiscal Year 2017-2018 ($1.8 million for direct patient care and $200,000 for administration of project).
BOARD OF SUPERVISORS STRATEGIC INITIATIVES:
__Economic Development
__Administration
_x_Health & Human Services
This project helps to serve the uninsured adult population of Monterey County by offering equitable opportunities for healthcare which will improve the health and quality of life for this demographic.
__Infrastructure
__Public Safety
Prepared and Approved by:
Elsa Jimenez, Director of Health
Gary R. Gray, Chief Executive Officer, NMC
Manny Gonzalez, Assistant CAO
Attachments:
Esperanza PowerPoint on file with the Clerk of the Board