Medically Indigent (WELL) Screening and Verification Pilot April 23, 2007

No Public Insurance Option 400% FPL 300% FPL 250% FPL 200% FPL 150% FPL 100% FPL Federal Poverty Level “Self-Pay” No Public Insurance Option Except Some Disease Related Services and Pre-Existing Conditions Pool Medicare San Mateo County Public Insurance/Coverage Offering By Population and FPL Healthy Families (being reviewed for AB774 compliance) Discounted Health Care WELL Healthy Kids Medi-Cal/AIM Medi-Cal WELL Fee Waiver Medi-Cal Medi-Cal Medi-Cal 0-18 Parents of Young Children Adults with Some Assets Pregnant Women Blind and Disabled Adults without Assets 65+ 19-64

Pilot Background General Fund contributions and loans to the Medical Center had doubled from $28M in FY2000 to $56M in FY2005 Self-declaration process prevented the County from quantifying its Section 17000 obligation to provide care to medically indigent residents One-e-App screening tool for Children’s Health Initiative presented an opportunity to screen all family members for coverage/assistance

County Goal Create a financially viable business model for providing healthcare to medically indigent residents

Major Milestones Began pilot in September 2005 based on recommendations from County workgroup Developed financial assistance policies with eligibility criteria for medically indigent (WELL) and low-income programs (December 2005) Eliminated self-declaration process and established full screening process that requires proof of income, assets and county residency (January 2006)

Major Milestones – January 2006 Modified One-e-App screening tool to include adult programs - Medi-Cal, WELL, DHC, other Trained users at 25 locations including Medical Center clinics, Health Department, Human Services Agency (HSA) and community-based organizations Created HSA audit team to verify eligibility for 20% of WELL and DHC applications

One-e-App Web-Based Electronic Application System

One-e-App Interview to Enrollment CBO or Community Clinic State DHS CHDP One-e-App Interview to Enrollment State SPE Healthy Families (SPE) Medi-Cal for Children (SPE) County Social Services Medi-Cal, ELE Rules Engine | Workflow Engine | Universal Interface Route Application Determine Preliminary Eligibility Submit Data & Document Storage & Retrieval County Healthy Kids CHI Health Plan County or County Hospital System County Indigent Programs Case Management Tools

One-e-App in other CA counties Alameda County Fresno County Humboldt County Los Angeles County City and County of San Francisco Orange County San Joaquin County Santa Cruz County

One-e-App Data Adult Applicants January 9, 2006 – January 5, 2007

applying for health coverage Information on 11,119 adults applying for health coverage Program Eligibility * City of Residence Age Gender Ethnicity Employment Household Size Legal Status Home Ownership * Only includes applications submitted in One-e-App. Applications submitted in CalWIN (Medi-Cal and other public assistance) are not included in data.

Program Eligibility 87% are eligible for WELL Those found eligible for WELL could also be eligible for Restricted Medi-Cal

City of Residence 38% live in South County

Age 35% of applicants are over 50

Gender 60% of applicants are female

Ethnicity 56% of applicants are Hispanic

Employment 59% of all applicants are employed

78% of WELL/DHC are employed (income range 100% - 400% FPL) * Includes WELL with fees/co-pays. Does not include WELL Fee Waiver (0-100% FPL) with only 41% working.

Household Size 46% are single applicants

Legal Status 77% indicate they are not here legally

Home Ownership 98% indicate they do not own a home

Uninsured Medical Center Patients Invision System January – December 2006

San Mateo Medical Center Uninsured Patients by Financial Class Total Uninsured 22,856 Total Non-WELL 13,019 Total WELL 9,837

Summary January – December 2006 25% decline in number of WELL members 13,054 in FY05 to 9,837 in 2006 597 enrolled in new Discounted Health Care (DHC) assistance program 12,422 Self-Pay about the same level as last year 248 (2%) have been screened in One-e-App Emergency room Clinic visits scheduled without screening Non-compliant population

Adult Medi-Cal Enrollments Show Upward Trend Source: San Mateo County Human Services Agency

Remaining Milestones - 2007 Complete interfaces between One-e-App and CalWIN (Medi-Cal) and Invision systems Determine permanent structure for applicant screening (children and adults), eligibility, enrollment, billing and collection, and audit functions moving forward Review financial assistance policies and propose revisions based on pilot experience, AB774, other adult coverage efforts

Remaining Milestones - 2007 Gather utilization and cost data on WELL patients Develop MOU with Medical Center for provision of services to medically indigent residents Explore alternatives for provision of healthcare to medically indigent residents

Contact Information Reyna Farrales, County Manager’s Office (650) 363-4130, rfarrales@co.sanmateo.ca.us