SANTA CRUZ COUNTYBOARD OF SUPERVISORS INDEX SHEET

Creation Date:

Source Code:

Agenda Date:

I NVENUM:

5/7/13

HSAX

5/14/13

67888

Resolution(s):

Ordinance(s):

Contract(s):

Continue Date(s): (1) 10/29/13

Index: --Letter of Health Services Agency dated April 23, 2013

--Low Income Health Program Organizational Chart--MediCruz Advantage Application and Enrollment Statistics--DHCS Policy and Procedure Letter: Low Income Health Program (L1HP) Establishment or

Removal of an Enrollment Cap

Item: 21. ACCEPTED AND FILED report on the Low Income Health Program implementationand directed staff to return with a status report on or before October 29, 2013 andauthorized the Health Services Agency to resume MediCruz Advantage programenrollment, effective July 1, 2013, as recommended by the Director of HealthServices

County of Santa Cruz 0087

HEALTH SERVICES AGENCYPOST OFFICE BOX 962,1080 EMELINE AVE., SANTA CRUZ, CA 95061..962

TELEPHONE: (831) 454-4000 FAX: (831) 454-4770 TOO: (831) 454-4123

HEALTH SERVICES AGENCYADMINISTRATION

BOARD OF SUPERVISORSCounty of Santa Cruz701 Ocean StreetSanta Cruz, CA 95060

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AGENDA: May 14, 2013

April 23,2013

SUBJECT: LOW INCOME HEALTH PROGRAM UPDATE

Dear Members of the Board:

This is a progress report on the implementation of the Low Income Health Program(L1HP), locally known as MediCruz Advantage (MCA), which was launched on January3,2012.

BACKGROUND INFORMATION

California's Low Income Health Program (L1HP) is an optional federal program thatoffers health coverage to uninsured legal residents in preparation for a Medi-Cal

expansion under the Patient Protection and Affordable Care Act (ACA), also known asfederal health care reform. As of the end of March 2013, 53 counties in California haveopted in to implement the L1HP. Under contract with the Centers for Medicaid andMedicare (CMS), statewide, all county L1HPs are scheduled to end December 31, 2013,and to transition eligible L1HP clients into the newly expanded Medi-Cal program.

On January 3, 2012, after almost 15 months of intensive community planning and

working through the application and contracting authorization process with the state andfederal agencies, and as approved by your Board, the L1HP for Santa Cruz County waslaunched under the administration of the Health Services Agency (HSA).

As contracted with CMS and based on available local funding match (50 percent of thedirect cost for this program requires local match funding), it was estimated that 2,000eligible uninsured County legal residents would be enrolled in the L1HP for the durationof the 24-month program (from January 2012 through December 2013).

HSA contracts with the Central California Alliance for Health (the Alliance) foradministrative services for L1HP with the exception of behavioral health and

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Low Income Health Program UpdateAgenda: May 14, 2013Page 2 of 4

pharmaceutical services, which are directly managed by HSA. The provider network forL1HP includes the HSA Emeline, Watsonville and Homeless Persons Health Project(HPHP) clinics, Salud Para La Gente, the Santa Cruz Women's Health Center, HSABehavioral Health, HSA Pharmacy and community pharmacies, Dominican, Watsonvilleand Sutter hospitals, specialists, laboratory and radiology providers under the contractwith the Alliance.

0088

Extensive outreach and planning efforts were conducted in collaboration andpartnership with local hospitals, the Human Services Department (HSD), the Alliance,and the Health Improvement Partnership (HIP) representing the Santa Cruz CountySafety Net Clinics Coalition. Over the past three years, HSA has secured four distinctBlue Shield of California Foundation competitive grants, totaling $560,000, for L1HP

planning, implementation, evaluation and transition efforts.

The County L1HP has established effective governance and business flow processes tomonitor the Program. Attachment 1 shows the organizational structure of the L1HP,which includes committees to review and make recommendations to the L1HP ExecutiveTeam for program quality improvement and cost monitoring and containment.

As a result of these efforts, Santa Cruz County L1HP was effeGtive in outreaching andenrolling clients into the Program as well as being able to monitor actual program cost ina timely manner.

PROGRESS UPDATE

· January 3, 2012: L1HP was launched and began to enroll eligible clients into theprogram. Enrollment took place at various clinic and emergency room sitesthroughout the County. 87% of the applications were taken and processed fromthe Emeline Clinic site where the majority of MediCruz program clients werereceiving indigent health care services (see Attachment 2).

· October 1, 2012: Due to high demand and effective outreach and enrollmentefforts, L1HP surpassed its enrollment expectations and was projecting to exceedthe financial resources available. Over 2,100 clients were enrolled in theProgram.

· October 16, 2012: Your Board adopted a Resolution limiting enrollment in theL1HP and authorizing HSA to execute all protocols with the State to impose anenrollment limitation for the Program.

· October 18, 2012: HSA executed all protocols with the State and receivedapproval to impose an enrollment limitation for L1HP until June 30, 2013. Awaiting list was established with periodic outreach and communication to theapplicants regarding their wait-list status.

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Low Income Health Program UpdateAgenda: May 14, 2013Page 3 of 4

· As of mid April 2013, there are nearly 500 eligible applicants on the waiting list.These wait-listed applicants are continuously screened for eligibility andcoverage through the County's indigent health Medicruz Program. Eighty percentof those on the L1HP wait list are receiving services through the MediCruz

program, which requires eligibility redetermination every three months.

0089

· HSA staff work closely with L1HP enrollees and assist them in applying for Medi-Cal when they become eligible. To date, 265 L1HP clients have transitioned ontoMedi-Cal since L1HP began.

· As required by the state and CMS, redetermination of L1HP client eligibility musttake place 12 months after enrollment. HSA began the redetermination processwith L1HP clients beginning in January 2013. As of April 2013, the renewal ratefor L1HP beneficiaries has an average 50%, which is in line with other countiesL1HPs renewal rates.

· Based on the trending rate of monthly eligibility redeterminations at 50%, HSAanticipates enrollment for L1HP will decrease from 2,100 to 1,200 by July 2013.Therefore, the HSA L1HP budget will be able to afford enrolling the clients on thewait list and end the program as scheduled in December 31, 2013.

It is anticipated that beginning in January 2014, Medi-Cal expansion will takeplace and all eligible L1HP enrollees would become eligible for Medi-Cal. In orderto allow as many eligible L1HP participants as possible to seamlessly transitioninto Medi-Cal, HSA requests your Board's authorization to allow the enrollmentlimitation to expire on June 30, 2013 (see Attachment 3 for DHCS policy andprocedure letter regarding establishment and removal of enrollment caps). Thiswill enable the program to enroll all eligible wait-listed individuals and othereligible MCA applicants beginning July 1, 2013, creating a smoother transitioninto Medi-Cal in January 2014.

SUMMARY

The Low Income Health Program surpassed its 2,000 beneficiary enrollment capacity inOctober 2012, and has instituted a waiting list for eligible enrollees. To date, theprogram is on track to remain within current year budgeted allocations. HSA and HSDstaff are planning for the transition from L1HP to Medi-Cal in 2014. With your Board'sapproval, HSA wil allow the enrollment limitation to expire on June 30, 2013, enablingprogram staff to enroll all eligible wait-listed individuals and other eligible L1HPapplicants beginning July 1, 2013.

11.;'

Low Income Health Program UpdateAgenda: May 14, 2013Page 4 of 4

It is, therefore, RECOMMENDED that your Board:

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1. Accept and file this report on the Low Income Health Program implementationand direct the Health Services Agency to return with an additional update no laterthan October 29, 2013.

2. Authorize the Health Services Agency to resume MediCruz Advantage programenrollment, effective July 1, 2013.

Sincerely, RECOMMENDED:

~County Administrative Officer

&iß;f~Giang T. NguyenHealth Services Agency Director

Attachments:

Attachment 1 - Low Income Health Program Organizational ChartAttachment 2 - MediCruz Advantage Application and Enrollment StatisticsAttachment 3 - DHCS policy and procedure letter: Low Income Health Program (L1HP)

Establishment or Removal of an Enrollment Cap

cc: Alcohol and Drug Advisory Board; Central California Alliance for Health;Dominican Hospital; Health Improvement Partnership Council; Human ServicesDepartment; Local Mental Health Board; Safety Net Clinic Coalition; SutterMaternity Hospital; Watsonville Hospital

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Low Income Health Prl.",.am UpdateAgenda: May 14, 2013

¡) H CS State of California-Health and Human Services AgencyDepartment of Health Care Services

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TOBY DOUGLASDIRECTOR

EDMUND G. BROWN JR.

GOVERNOR

October 11 , 2012

PPL: 12-002

To: ALL LOCAL LOW INCOME HEALTH PROGRAMS

Subject: Low Income Health Program (L1HP) Establishment and Removal of anEnrollment Cap.

This policy and procedure letter is to provide guidance regarding the establishment orremoval of an enrollment cap by local L1HPs.

Background

The UHP consists of the Medicaid Coverage Expansion (MCE) and the Health CareCoverage Initiative (HCCI) programs. These programs provide health care benefis toeligible persons in accordance with the Welfare and Institutions Code (W&I) Sections15909 - 15915 and the Special Terms and Conditions (STCs) of the Social Security Actsection 1115(a) Medicaid Demonstration Project for the State of California (Bridge toReform). The Bridge to Reform was approved by the Centers for Medicare & MedicaidServices effective November 1, 2010. The L1HP is a voluntary program administeredand implemented at the local leveL.

Enrollment Cap

In accordance with STC 58.c-d, W&I Section 15910(h), and the L1HP contracts betweenthe local LlHPs and the Departent of Health Care Services (DHCS), Exhibit A,

Attachment 14, Provision 1.D, a local LlHP may establish an enrollment cap in an eventthat it determines it cannot continue to enroll applicants without exceeding availablefunding based on advanced budget projections and available local funds. If the localL1HP implemented an HCCI program, an enrollment cap for the MCE program may notbe established before the HCCI enrollment cap is established. However, the HCCI andMCE programs may be capped at the same time.

An enrollment cap controls local LlHP program costs in order for the current L1HPenrollees to continue to receive health care services. An enrollment cap in the HCCIprogram would close the HCCI program to any new enrollees regardless of HCCIdisenrollments. An enrollment cap in the MCE program would close the MCE programto any new enrollees regardless of MCE disenrol1ments. An enrollment cap in the MCEprogram applies to all MCE enrollees, including state and local inmates. If an enrolleeis disenrolled and re-applies when a program is capped, he or she may not be

Low Income Health Program DívisionP.O. Box 997436, MS 4614, Sacramento, CA 95899.7436

Phone: (916) 552.9193Internet Address: http://ww.DHCS.ca.gov 10f311

Low Income Health Pro~,dm UpdateAgenda: May 14, 2013

ALL LOCAL LOW INCOME HEALTH PROGRAMSPage 2October 11,2012

Attachment 3

0096

re-enrolled during the time the cap is in place. An enrollment cap will expireautomatically at the end of each state fiscal year and at the end of the program onDecember 31,2013.

Before an enrollment cap can be established, a local UHP must submit a completed"UHP Enrollment Cap Request," (template enclosed) to DHCS for approval Therequest must be signed by the individual authorized to sign on behalf of the UHP andsubmitted to DHCS at least 30 business days prior to the effective date of theestablishment of an enrollment cap. Additionally, a governing board resolutionapproving the proposed enrollment cap must be submitted to DHCS prior to approval ofthe enrollment cap within this timeframe. The local LlHP wil be notified of DHCS'sdecision by the end of the 30-business day period.

A local LlHP must notify DHCS that it intends to remove an enrollment cap. Removal ofan established enrollment cap requires 5 business days notification to DHCS before theeffective date of removaL. This notific~tion must include the L1HP program(s) for whichthe enrollment cap is being removed and the effective date of removaL.

The completed enrollment cap request or the written notification of enrollment capremoval shall be submitted bye-mail to Bob Baxter, Chief, LlHP Implementation Section(Bob.Baxter@dhcs.ca.gov), with a copy to the UHP mailbox (L1HP@dhcs.ca.gov).

Wa.it Lists

If a local UHP has established an enrollment cap, it may maintain wait lists forenrollment into the appropriate program(s). The local UHP is not required to determinean applicant's eligibilty prior to placing the individual on a wait list. If the local UHPmaintains a wait list, it must perform outreach to the individuals on the wait list duringthe first six (6) months from the date they are placed on the wait list, to afford thoseindividuals the opportunity to apply for other programs. Outreach includes, but is notlimited to, distribution of written material to each individual on the waiting list. Thewritten material shall include at a minimum a reminder to apply for Medi-Cal, at anytime, if the individual is stil seeking coverage. Outreach materials will remindindividuals that they can apply for any other health care sources available to them atany time.

If you have any questions regarding this information, please contact Bob Baxter, Chief,L1HP Implementation Section at Bob.Baxter@dhcs.ca.gov.

Sincerely,/1 ./)/ (¡"U'P'?7'-' L ú:£¿~~aiynne Callori, Chief

Low Income Health Program Division

Enclosure

112 of 3

Low Income Health Prú::.dm UpdateAgenda: May 14, 2013 Attachment 3

0097DATE: (DateJ

TO: low Income Health ProgramDepartment of Health Care Services

FROM: (Program NameJ

(Contractor Nome)(Contractor Address)

Instructions: Complete the following table using data from the current fiscal year.Insert "N/A" for program for which a cap is not requested;Insert enrollment numbers where requested;Insert dollar amounts where requested;Insert dates where requested.

ProgramMCE Hcei I

1. Program(s) requested to be capped for enrollment (Y or N) Ii

2. Projected enrollment as of effective date of capI

3. Requested effective date of cap (mm/dd/vy) i~

4. Budgeted amountof TFEs1 available for current year ($)I

5. Estimated year-to-date TFEs as of the most recent available month ,

Iending prior to effective date of cap ($)"As of' date (mm/dd/vy)

i.6. Actual TFEs for the most recent available month (S)

. Month/year( mm/vy)7. Projected TFEs for remaining months of fiscal year ($)8. Wil a waiting list be established for capped program? (Y, N, or N/A)

9. Rationale for Enrollment Cap

Describe the factors and trends associated with the decision to establish on enrollment cop inthe local LlHP, and include the local LlHP's expenditure rates, and projected dote when TFEexpenditures wil surpass budget amounts.

10. (Program Nome) Contact Information:

(Name, Title)(Telephone NumberJ(Em aU)

(Signature of authorized individual, including printed name and title!

1 TFEs (Total Funds Expenditures) means the total allowable costs incurred by the Contractor for covered

services, pursuant to the L1HP contract, provided to LlHP enrollees.

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