RECOMMENDATION(S): (CONT'D)
2. APPROVE and AUTHORIZE the Health Services Director or designee to execute a contract with Contra Costa Community Clinic Consortium (Consortium) to accept funds in an amount up to $500,000 for the purpose of disbursing payment to community clinics providing primary healthcare to enrollees in the Contra Costa CARES program on a per-participant, per-month basis contingent on final approval by local hospitals of their contribution of $500,000 to this program.
3. APPROVE and AUTHORIZE the Health Services Director to allocate up to $500,000 in County funding to disperse to participating community clinics on a per-participant, per-month basis for primary care services provided under the Contra Costa CARES program contingent on final approval by local hospitals of their contribution of $500,000 to this program.
4. AUTHORIZE Contra Costa Health Plan to become the fiscal agent, manage enrollments, and track utilization for the Contra Costa CARES Program.
FISCAL IMPACT:
100% County General Fund in the amount of $500,000. Proceeds from the State’s one-time payment of the County's State Mandated Funding claim (SB 90) will be utilized.
BACKGROUND:
Passage of the Affordable Care Act (ACA) increased access to health coverage for most low-income adults and children living in Contra Costa County. An estimated 19,000 adults living in Contra Costa are ineligible for Covered California or full-scope Medi-Cal. Contra Costa CARES will provide comprehensive primary health care coverage and medical homes to approximately 3,000 low income, uninsured adults residing in Contra Costa who do not qualify for full-scope Medi-Cal or Covered California. The program will take full advantage of PRUCOL (Permanent Residence Under Color of Law) and other state coverage programs. Eligible participants must apply for state programs such as FamilyPACT, Every Woman Counts, and Breast Cancer Early Detection Program.
The program will cover uninsured adults 19 years of age or older living in Contra Costa who are ineligible for full-scope Medi-Cal or Covered California and whose household gross income does not exceed 138% of the Federal Poverty Level (Household of 1 individual = $16,105; Family of 4 = $32,913 annual income).
The program will cover primary care services including basic laboratory and radiology services. Specialty care, dental, vision, emergency care and hospitalization are not covered benefits of the program.
Participating primary care providers are La Clínica de la Raza, LifeLong Health Care, Brighter Beginnings, and Axis Health Care. Providers will receive on a capitated basis $28.00 per-participant, per-month for a total annual cost of $336.00. The program anticipates enrolling up to 3,000 individuals. Contra Costa Health Plan will be the fiscal agent and manage the program by issuing membership cards to participants, educate new enrollees about the benefits of the program and the use of their medical home, provide nurse advice services and link enrollment information electronically between primary care providers and hospital emergency room staff.
The proposed Contra Costa CARES program was developed through an extensive planning process representing many local stakeholders over the past year with leadership provided by Contra Costa Health Services, Hospital Council of Northern & Central California and the Contra Costa Community Clinic Consortium including representatives from Kaiser Permanente, Sutter-Delta Medical Center, John Muir Health, La Clínica de la Raza, LifeLong Medical Care, Brighter Beginnings, and Planned Parenthood. The planning process was funded by grants from the Blue Shield of California Foundation and John Muir/Mt. Diablo Community Health Fund.
Local hospital representatives have recommended to their leadership and Boards that they contribute cumulative funding of $500,000 to establish Contra Costa CARES. The Boards of Directors of local hospitals will be taking action on this recommendation in the near future. There is strong support among the business community (support letter from East Bay Leadership Forum representing Contra Costa businesses and industry), labor community (support letter from Contra Costa Central Labor Council), and numerous community based and faith organizations (support letters attached to this Board Order).
CONSEQUENCE OF NEGATIVE ACTION:
Low income, uninsured adults residing in Contra Costa County who do not qualify for full-scope Medi-Cal or Covered California will not have access to primary, preventative care services and may utilize more expensive hospital emergency departments for their care.
The uninsured have lower screening rates for preventable health conditions and experience poor health outcomes for chronic diseases such as diabetes, hypertension and other conditions. Lack of access to care puts residents at higher risk of serious health problems and premature death.
Infectious diseases such as influenza, measles and tuberculosis may not be detected early before affecting populations living and working in the County. Preventative and primary care are significantly less expensive to administer than it is to treat severe chronic illness and diseases. Having access to primary care not only benefits patients, there is cost-savings to the County's public health, hospital emergency departments, and the general public.
CLERK'S ADDENDUM
Speakers: Mary Helen Rocha, United Latino Voices/Antioch City Council; Marianna Moore, Rebecca Rozen, Hospital Council; Katia Reges, resident of Antioch; Patricia Snyder, League of Women Voters – Diablo Valley; Brenda Quintana, Latino Caucus California State Association of Counties; John Wilson; Michael Saragosa, APAPA Asian Pacific Islander American Public Affairs Association; Lee Lawrence, CCISCO; Reverend Fred Weidmann, Multifaith Action Coalition of Contra Costa County; Emily Ross, resident of Richmond; Melody Howe Weintraub, Multifaith Action Coalition; ; Will White, United Way of the Bay Area; Reverend ; John Wilson; Nicole Regalado, Planned Parenthood Northern California; Mary Harms, Central Labor Council; Gail Fienweiss, ACCE, resident of Richmond; Patricia Aguiar, ACCE; David Sharples, resident of Richmond; Javana Fajardo, resident of Concord; Chris Keifer, Lifelong Medical; Andre Soto, RPA, CBE; Koak Huber, resident of Richmond; Carol Weed, M.D. Organizing for Action; Melvin Willis, ACCE,
Rosa Arriaga, resident of Richmond; Rosalva Reyes, ACCE via interpreter; Edith Pastrano; Donnell Jones, CCISCO; Tim Laidman, Green Party of Contra Costa; Kathleen Wimer, resident of Richmond; Gabriel Hagland, SEIU 1021; Millie Cleveland, resident of Oakley; Koak Huber, resident of Richmond; Patricia Dalbey, Antioch; Rose Auguste, Health Access California Alvaro Fuentes, Community Clinic Consortium; Dan Jameyson, SEIU 1021; Anthony Wright, Executive Director Health Access California; Ricardo Davis; Cassie Romero Gonzalez; Rosa Escarilla; Maria Reyes; Kathleen Wimer; Zak Wear; Nicole Regalado; Donnell Jonel, CCISCO.
Written comments provided by Oraneet Shikmah Orevi, resident of Berkeley; Gwen Watso, Multi Faith Action, Social Justice Alliance; Viola Lujan, La Clinica de La Raza; Emily Ross, resident of Richmond; Pat Daily, resident of Pleasant Hill.
APPROVED and AUTHORIZED the Health Services Director to establish a Contra Costa CARES program for the purpose of providing primary healthcare services to adults not covered by the Affordable Care Act;
APPROVED and AUTHORIZED the Health Services Director or designee to execute a contract with Contra Costa Community Clinic Consortium (Consortium) to accept funds in an amount up to $500,000 for the purpose of disbursing payment to community clinics providing primary healthcare to enrollees in the Contra Costa CARES program on a per-participant, per-month basis contingent on final approval by local hospitals of their contribution of $500,000 to this program;
APPROVED and AUTHORIZED the Health Services Director to allocate up to $500,000 in County funding to disperse to participating community clinics on a per-participant, per-month basis for primary care services provided under the Contra Costa CARES program contingent on final approval by local hospitals of their contribution of $500,000 to this program; and
DIRECTED the Health Services Department to work with hospitals, community clinics and other relevant stakeholders, to return to the Board regarding the management of the program.
A request for appropriation of funds will come to the Board at a future date.