1100 K Street, Suite 101/Sacramento, CA 95814/ (916) 327-7531 FAX (916) 491-4182
1100 “K” Street, Suite 101/Sacramento, CA 95814/ (916) 327-7531 FAX (916) 491-4182/
November 4, 2005
TO:Rene Mollow, MSN, RN
Associate Director, Health Policy
From:Casey Kaneko
RE:Healthcare Coverage Initiative
The Department of Health Services has invited the Urban Counties Caucus to respond to a series of questions regarding the Healthcare Coverage Initiative of the Medi-Cal Hospital/Uninsured Care Demonstration Waiver. Due to the short time allowed for responses, the UCC Board of Directors has not reviewed the information, but county staff has discussed the concept of a Health Coverage Initiative similar to the model outlined here. Therefore, these comments should be considered as preliminary. The Urban Counties Caucus Board will meet on November 30, 2005 and one of the items on the Board’s agenda will be a UCC proposal for the Health Coverage Initiative. The proposal under discussion is consistent with the information below.
Who should be covered?
Uninsured adults age 18 – 64 under 100% FPL and possibly uninsured parents of children on Medi-Cal and Healthy Families, particularly those who are chronically ill or who frequently use hospital emergency rooms. The program would not be an entitlement and would be based on available funding.
What services should be provided?
Inpatient, outpatient, and prescription drug services would be provided. Each enrollee would be given a coverage card that could be presented for care at a participating provider as described below. Each enrollee would be assigned to a primary care provider who would help provide case management services such as telephone nurse, health education, and self-care support services to improve enrollee health and promote the prudent and appropriate use of health care services. The goal would be better outcomes for the enrollees, improved services by public safety net providers, and reduced demand on the Medi-Cal program.
What would constitute a “participating provider?”
The program would be administered through a county-defined network of public hospitals, clinics, and contract providers. The public hospitals would be those county and University of California hospitals enumerated in the Medi-Cal Hospital/Uninsured Care Demonstration Waiver.
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Rene Mollow, MSN, RN
Should it be implemented statewide or in limited areas (as pilot projects or optional county programs)?
Because the program is intended to provide access to Safety Net Care Pool funds made available through the Medi-Cal Hospital/Uninsured Care Demonstration Waiver, it would be administered in those counties with public hospitals enumerated in the Waiver that chose to participate.
What sort of matching funds would be available for this purpose?
Counties would submit for matching with Safety Net Care Pool funds those local funds that they spend on providing care for the above-mentioned population, provided those funds are not used for Certified Public Expenditures elsewhere under the Waiver.
Board of Directors: Chair: Supervisor Rich Gordon, San Mateo County Vice Chair: Supervisor John Tavaglione, Riverside County Treasurer: John Guthrie, Finance Director, Santa Clara County Members: Supervisor Keith Carson, Alameda County; Supervisor John Gioia, Contra Costa County; Supervisor Don Knabe, Los Angeles County; Supervisor Tom Wilson, Orange County; Supervisor Roger Dickinson, Sacramento County; Supervisor Paul Biane, San Bernardino County; Supervisor Greg Cox, San Diego County; Supervisor Chris Daly, San Francisco County; Supervisor James Beall, Jr., Santa Clara County; Supervisor Kathy Long, Ventura County.