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

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

2. 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 Healthy Families San Mateo County Public Insurance/Coverage Offering By Population and FPL Discounted Health Care (being reviewed for AB774 compliance) WELL Healthy Kids Medi-Cal/AIM Medi-Cal WELL Fee Waiver Medi-Cal Medi-Cal Medi-Cal Parents of Young Children 0-18 Adults with Some Assets Adults without Assets Pregnant Women Blind and Disabled 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 17000 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. CBO or Community Clinic State DHS State SPE CHDP Healthy Families (SPE) Medi-Cal for Children (SPE) Rules Engine | Workflow Engine | Universal Interface County Social Services Determine Preliminary Eligibility Route Application Submit Application Medi-Cal, ELE County Healthy Kids County Indigent Programs Case Management Tools Data & Document Storage & Retrieval CHI Health Plan County or County Hospital System One-e-App Interview to Enrollment

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. 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 Eligibility87% are eligible for WELL Those found eligible for WELL could also be eligible for Restricted Medi-Cal

13. City of Residence38% live in South County

14. Age35% of applicants are over 50

15. Gender60% of applicants are female

16. Ethnicity 56% of applicants are Hispanic

17. Employment59% 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 Size46% are single applicants

20. Legal Status77% indicate they are not here legally

21. Home Ownership98% 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) 363-4130, rfarrales@co.sanmateo.ca.us