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

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

3. Healthy San Francisco (HSF) July 2007
SF Medical Home-based care, not insurance
Services in SF for residents 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

4. 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 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
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

5. 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, Dec. 31, 2013
Timed with January 1, 2014 implementation of individual mandate under Affordable Care Act

6. 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

7. 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

8. 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