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Consider the nomination of a Solano County representative to the County Medical Services Program Governing Board
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Published Notice Required? Yes ___ No _x_
Public Hearing Required? Yes ___ No _x_
DEPARTMENTAL RECOMMENDATION:
The County Administrator’s Office recommends the Board of Supervisors consider the nomination of a Solano County representative to the County Medical Services Program (CMSP) Governing Board.
SUMMARY:
The County Medical Services Program (CMSP) was established in 1983 to provide healthcare coverage for low-income adults in California's smaller counties. Today, CMSP serves 35 participating counties and continues to provide coverage for eligible uninsured residents as changes to Medi-Cal eligibility and funding occur. The CMSP Governing Board, established in 1995, provides overall program and fiscal oversight and consists of ten elected county officials representing participating counties and one non-voting state representative.
Supervisor John Vasquez joined the CMSP Governing Board in May 2023 and has since stepped down, creating a vacancy for the remainder of the term ending December 31, 2027. The replacement must be a current County Supervisor from a participating CMSP county and, because this is the Group 3 Supervisor seat, must come from Marin, Napa, Solano, or Sonoma County. However, with Marin and Napa already represented on the Governing Board, only Solano or Sonoma County may nominate a candidate, who will be elected by the participating CMSP County Supervisors.
FINANCIAL IMPACT:
Nomination of a representative has no direct fiscal impact. However, the CMSP Governing Board is responsible for maintaining the fiscal soundness of the CMSP benefit program and the overall CMSP budget, which will have future impacts on Solano County.
DISCUSSION:
The County Medical Services Program was established in 1983, when California law eliminated low-income adults from Medi-Cal and transferred responsibility for their health care to California counties. This law recognized that many smaller, rural counties were not in the position to assume this new responsibility, and provided counties with a population of 300,000 or fewer with the option of contracting back with the State to provide these health care services through CMSP. The State Department of Health Services (DHS) utilized the administrative infrastructure of Medi-Cal’s fee-for-service program to administer CMSP.
1991 Realignment revenue was the primary revenue source supporting CMSP. In 2013, the Affordable Care Act (ACA) expanded Medi-Cal to cover low-income uninsured adults and Realignment was substantially revised under AB85 and most revenue previously dedicated to indigent health care was redirected to the State of California. Counties participating in CMSP retained only a portion of the revenue for continued provision of health care services to the remaining uninsured left uncovered by the ACA. With the current federal program changes under H.R. 1 and additional State changes in Medi-Cal coverage, CMSP will need to undergo significant changes to ensure health coverage for many Californians.
The CMSP Governing Board was established by California law in April 1995. The Board has overall program and fiscal responsibility for CMSP. Under its authorities set forth in Welfare and Institutions Code Section 16809, the Governing Board has responsibility for setting program eligibility standards, defining the scope of covered healthcare benefits, and determining payment rates for healthcare providers delivering emergency and non-emergency services to CMSP members.
The Governing Board is composed of eleven members. Ten members are county officials who are elected by the thirty-five participating CMSP counties. The Governing Board consists of three County Supervisors, three County Administrative Officers, two County Health Officials and two County Welfare Directors. One member of the Governing Board is an ex-officio, non-voting representative of the California Health and Human Services Agency. The Governing Board generally meets six times per year.
Supervisor John Vasquez joined the CMSP Governing Board in May 2023, following the resignation of former Solano County Supervisor Erin Hannigan in March 2023. Supervisor Vasquez has stepped down from the Governing Board as of July 2026. CMSP will be seeking a Board Member to fulfill the remainder of Supervisor Vasquez’s term of January 1, 2025 through December 31, 2027.
To serve as a voting member of the CMSP Governing Board, an individual must:
• Hold office or employment in a participating CMSP county. A board member must be a current county official or employee in one of the 35 counties participating in CMSP.
• Serve in one of four designated county leadership roles:
o County Supervisor (3 seats)
o County Administrative Officer/County Executive Officer (3 seats)
o County Welfare Director (2 seats)
o County Health Official (2 seats)
• Be elected or selected by peers from participating CMSP counties:
o County Supervisors are elected by the Boards of Supervisors of the participating counties.
o County Administrative Officers are elected by the participating counties' CAOs.
o County Health Officials are selected by the participating counties' Health Officials.
o County Welfare Directors are elected by the participating counties' Welfare Directors.
• Serve a three-year term. Members may be reelected if selected again by their peers.
• Not serve concurrently with another representative from the same county. No two voting members may come from the same county at the same time. This ensures geographic diversity across the 35 participating counties.
In addition, the member fulfilling the remainder of the term must be from the same Governing Board County Group as the previous member. Solano County is from Governing Board Group 3, which is composed of Marin, Napa, Solano, and Sonoma Counties. Marin and Napa currently have representatives on the Governing Board, precluding them from nominating a representative. Should Solano County nominate a representative, that representative will be put forth in an election where CMSP County Supervisors will make the final selection.
ALTERNATIVES:
The Board may choose not to nominate a representative. This is not recommended as the nomination provides an opportunity to have representation from Solano County on the CMSP Governing Board.
OTHER AGENCY INVOLVEMENT:
None.
CAO RECOMMENDATION:
APPROVE DEPARTMENTAL RECOMMENDATION