1. Financing Mechanism Workgroup Ron Robinson, Chair

2. Reminder: Workgroup Charge To quantify current costs for uninsured adults, to assign cost estimates to various expansion models and to provide recommendations for financing adult health care expansion

3. Two Pronged Approach 1. Current and Future Financing for Care to the Uninsured 2. Determining the Ranges of Cost for San Mateo Specific Expansion

4. Current and Future Financing for Care to the Uninsured

5. Current Cost of Care to the Uninsured Cost of Care (range based on data differences) San Mateo Medical Center (incl. WELL) $48 million to $53.6 million Private Hospitals$12.7 million Free and Community Clinics$6.1 million GRAND TOTAL$66.8 million to $72.4 million

6. Current Funding for Care to the Uninsured Funding sources dedicated to health care for the uninsured (2005)  Realignment: $21,441,052  Required County Match: $6,786,043  County Over-Match: $8,385,171 (FY 03-04)  Prop 99: $442,223  SB 12/Maddy: $1,136,905  Net DSH: $4,857,775  Tobacco Settlement: $7,645,903 TOTAL: $50,695,071 Source: CDHS, OCHS, San Mateo County Health Dept., CA Attorney General

7. Potential Revenue Generation for Care to the Uninsured a) Under the Legal Powers of a County Entity  Mandated Participation  Voluntary Participation b) Requiring State/Federal Legislative Changes to Enact

8. Potential Revenue Generation Voluntary Participation Charge Patient Differential at Point of Service as Incentive to Purchase Individual Coverage Offer Product for Businesses to Participate/Individuals to Participate

9. Potential Revenue Generation Mandated Participation Options Consolidate and Expand Health Care District Tax Charge Differential at Point of Service Increase Licensing Fees Transient Occupancy Tax/Lodging Tax Parcel Tax Increase Sales Tax Business License Tax

10. Potential Revenue Generation Requiring Legislative Change Federal Demonstration Waiver for Local Expansion Legislation Allowing Counties to Impose a Payroll Tax Legislation Allowing Provider Tax/Services Tax Legislation Allowing Mitigation Fee for Businesses/Free Rider Fee

11. Initial Financing Concept The County The Community  Hospitals and Health Care Districts  Businesses  Tax/Fee Individuals

12. Uninsured Adult ??? Employer Offers HPSM Subsidized Insurance Product Adult Covered through New Program Working w. Employer Sponsor Uninsured Adult Not Working or Working w/o Employer Sponsor Uninsured Adult YN Adult Covered through New Program Adult Insured through HPSM Subsidized Insurance Product Below 400% FPL? Y N Individual Offered HPSM Insurance Product Y Employer Offered HPSM Insurance Product Expansion Funding Sources/ Flow Option I

13. Costs of San Mateo Adult Coverage Expansion

14. Coverage versus Insurance Medi-Cal Share of Cost County Mental Health Medi-Cal and Aim for Pregnant Women Family PACT 340B Drug Pricing County Drug Treatment Medi-Cal Limited Coverage

15. Cost-Sharing Analysis Survey of 400 Uninsured Adults  Spanish, Mandarin, English  Health Care Settings, CHI Outreach Sites, Churches and Community Events Intended to Determine Cost-Sharing Amounts for Uninsured Adults

16. Working with an Actuary Three Models Sent to an Actuary Requested Several Cost-Estimates Will Return Estimates in April Refine and Adjust Assumptions

17. Next Steps Joint Meeting of Model and Financing Workgroups Actuarial Estimates Returned Revenue Generation $$ Estimates Focus Groups with Business Community Client Cost Sharing Analysis Completed

18. County Counsel Analysis Mitigation Fee Payroll Tax Health Officer Authority