San Francisco: LIHP transitions to ACA coverage Alice Gleghorn, Ph.D. San Francisco AOD Administrator

Healthcare Milestones: 2005-Mayor Gavin Newsom call for Universal Healthcare 2006- SF Health Care Security Ordinance Jan 2007- HCCI application submitted July 2007-Healthy San Francisco launched September 1, 2007- June 30, 2011- HCCI July 1, 2011- Dec 31, 2013- LIHP in effect

Healthy San Francisco (HSF) July 2007 SF Medical Home-based care, not insurance Services in SF for residents 18-64 with income/ assets up to 500%FPL who are ineligible for public coverage such as MediCal Quarterly Income-based Participant fee & POS fee Phased enrollment to reach to 500% FPL One-e-App- assess eligibility/enroll in HSF, ID’d HCCI Unique Client ID Preliminary eligibility determination for other public programs Verification of residency, etc. (document imaging) Current enrollment status Rapid renewal process Routing eligibility to registration and billing Initial DPH Service sites (PC, Hospital, CBHS) ADDED addt’l PC (N=37) and all hospitals except VAMC

Prior 1115 Waiver - Health Care Coverage Initiative (HCCI) -HCCI goal- provide 100,000 uninsured CA adults with comprehensive care and access to a primary medical home -Competitive State application -- 10 counties selected -In San Francisco, HCCI funded Healthy San Francisco -HCCI reimbursement limited to HSF participants who met federal criteria: --Uninsured adult aged 19 – 64 --San Francisco resident --Income at or below 200% FPL --2005 Deficit Reduction Act (ID&legal status) -San Francisco’s HCCI network-SFDPH (PC, SFGH, CBHS) -DPH had over 10,000 HSF participants with HCCI-eligibility -HCCI effective September 1, 2007 to June 30, 2011

New 1115 Waiver - Low Income Health Program (LIHP) California’s “Bridge to Reform” Medicaid 1115 Waiver LIHP goal-“expand coverage to low-income Californians” Voluntary County participation in LIHP with exception of 10 HCCI counties -CA LIHP enrollment goal≈ 500,000 low-income adults Effective July 1, 2011- Dec. 31, 2013 Timed with January 1, 2014 implementation of individual mandate under Affordable Care Act

LIHP Eligibility LIHP covers individuals who are: Between the ages of 19 and 64 U.S. citizens or qualified immigrants Have U.S. government identification Residents of the program county Not pregnant Not eligible for Medi-Cal or S-CHIP Between 0% and 200% FPL 2 coverage populations and benefits based on FPL Medicaid Coverage Expansion (MCE)- required incomes between 0% - 133% FPL Health Care Coverage Initiative (HCCI)- optional incomes between 134% - 200% FPL

LIHP= SF Path SF Provides Access to Health care Care at DPH Medical Homes Impact of Ryan White enrollees in LIHP MCE Restricted to 0-25% FPL @11,000 enrollees On 1/1/14- ALL LIHP patients become the MediCAL newly eligible population

Immediate SF PATH Enrollment Goals Target 11,000 uninsured clients in MH/SA Also 3,000 uninsured in DPH Healthy SF (20,000 HSF at non-DPH medical homes) Train 40 new enrollers by next week Hold Project Homeless Connect event At annual re-enrollment, HSF clients who are eligible for covered CA or MediCAL are no longer eligible for HSF and must change