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Approve an agreement with the California Department of Health Care Services to participate in the FY2019/20 Medi-Cal County Inmate Program with a maximum reimbursable amount not to exceed $604,282; Authorize the County Administrator to sign the agreement and any amendments including changes to terms and conditions and scope of services, with concurrence from County Counsel; and Authorize the Sheriff or his designee to execute contract amendments which are technical and administrative in nature and remain within budget appropriations
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Published Notice Required? Yes ____ No _X _
Public Hearing Required? Yes ____ No _X _
DEPARTMENTAL RECOMMENDATION:
The Sheriff’s Office recommends that the Board of Supervisors:
1. Approve agreement number 19-96191 with the California Department of Health Care Services to participate in the FY2019/20 Medi-Cal County Inmate Program with a maximum reimbursable amount not to exceed $604,282;
2. Authorize the County Administrator to sign the agreement and any amendments including changes to terms and conditions and scope of services, with concurrence from County Counsel; and
3. Authorize the Sheriff or his designee to execute contract amendments which are technical and administrative in nature and remain within budget appropriations.
SUMMARY:
The Medi-Cal County Inmate Program (MCIP) is a voluntary, fee-for-service only program administered by the California Department of Health Care Services (DHCS) that allows counties or medical providers to draw down federal Medicaid funding for inmates who are treated for more than 24 hours at medical facilities that are offsite or separate from county jails. The MCIP consequently creates budgetary savings for the County for the medical care provided to its Medi-Cal eligible inmates.
Solano County has participated in the MCIP since April 2017 and in April 2019, the County submitted a County Participation Form for FY2019/20 which indicated that the County was interested in voluntarily participating in the MCIP from July 1, 2019 to June 30, 2020. Continued participation requires the Board of Supervisors approve a MCIP agreement and return the signed agreement and a meeting minute order indicating Board approval to DHCS.
FINANCIAL IMPACT:
Under MCIP, the County's inmate medical provider, Wellpath, realizes savings for inpatient hospitalization or medical care costs they would have otherwise paid. In turn, Wellpath reimburses the County for the State's 5% administrative fee and pays the County 85% of the net savings from inmates covered under MCIP. Board approval will not impact the County General Fund; however, non-approval will negatively impact County General Fund as the Sheriff's Recommended Budget includes $180,000 in revenue from Wellpath for inmates covered under MCIP.
To date, Solano County has received $121,635 from Wellpath for participation in the MCIP program through June 30, 2018 for inmates who received inpatient medical treatment. Additionally, there is $58,539 due in payments from Wellpath for the period July 1, 2018 through December 31, 2018. The claims reimbursement process can be lengthy, given that a Medi-Cal provider (NorthBay) only submits claims after all eligible costs have been determined, and the State’s release of funds is predicated on the review and appeals process.
The costs associated with preparing this agenda item are nominal and absorbed by the department’s FY2019/20 Adopted Budget.
DISCUSSION:
The DHCS implemented the voluntary MCIP beginning April 1, 2017. The MCIP consists of three programs: the Adult County Inmate Program (ACIP), the County Compassionate Release/Medical Parole Program (CCRP/CCMP), and the Juvenile County Ward Program. The first, and most noteworthy, is the ACIP which covers Medi-Cal allowable inpatient hospital services during an eligible inmate’s inpatient hospital stay. The second program is the CCRP/CCMP which allows the Sheriff to grant medical release or medical probation in lieu of jail time, if certain conditions are met. An inmate may only be eligible for CCRP/CCMP if the physician determines the inmate has a life expectancy of six months or less; the inmate does not pose a threat to the public's safety; the presiding judge is notified of the intended release; and inmate placement is secured. The third program involves juveniles housed in county juvenile halls and is of interest to the County’s Probation Department.
Since FY2016/17, with Board approval, the County has participated in the Adult County Inmate Program under the MCIP. The current contract with Wellpath, the County’s contract inmate medical provider, is a full cost model, under which Wellpath is required to pay for inpatient medical treatment if they approve the treatment. Under MCIP, instead of billing Wellpath for treatment, NorthBay seeks reimbursement from the State under Medi-Cal, enabling Wellpath to realize savings. For FY2019/20, the authorized limit for reimbursement from the State is $600,000. Since Wellpath benefits from lower inmate medical costs resulting from accepted MCIP claims, Wellpath pays the County 85% of its net savings of the claimed amount, retaining the remaining 10% for administrative costs. The 10% retention by Wellpath is a standard administrative fee for MCIP in all their contracts with other counties. In order to participate in the MCIP program, the County is charged a 5% state administrative fee which is entirely offset by Wellpath reimbursement.
Working in collaboration with Wellpath and NorthBay, County Health and Social Services (H&SS) and the Sheriff’s Office are responsible for identifying inmates admitted for covered inpatient off-site hospital or medical services; obtaining appropriate authorized representative forms from inmates; working with inmates to complete and sign Medi-Cal application documents; and enroll the inmates by submitting completed Medi-Cal applications and support documentation to the DHCS.
ALTERNATIVES:
The Board of Supervisors could choose not to approve the agreement between Solano County and DHCS; however, this alternative is not recommended as it would exclude the State, the County's inmate medical provider Wellpath, and the County from benefiting from the MCIP for inpatient hospitalizations of Solano County inmates. Moreover, non-approval is not fiscally prudent, as this revenue stream aids in reducing General Fund costs associated with inmate medical expenses.
OTHER AGENCY INVOLVEMENT:
County Counsel has reviewed and approved the contract as to form.
CAO RECOMMENDATION:
APPROVE DEPARTMENTAL RECOMMENDATION