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

2. 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

3. 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 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

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

5. 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)

6. 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

7. One-e-App Web-Based Electronic Application System

8. 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

9. 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

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

11. 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.

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

13. City of Residence 38% live in South County

14. Age 35% of applicants are over 50

15. Gender 60% of applicants are female

16. Ethnicity 56% of applicants are Hispanic

17. Employment 59% of all applicants are employed

18. 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.

19. Household Size 46% are single applicants

20. Legal Status 77% indicate they are not here legally

21. Home Ownership 98% indicate they do not own a home

22. Uninsured Medical Center Patients
Invision System
January – December 2006

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

24. 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

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

26. 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

27. 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

28. Contact Information
Reyna Farrales, County Manager’s Office
(650) ,