TO: Board of Supervisors
FROM: Jennifer Yasumoto, Director of Health and Human Services Agency
REPORT BY: Summer Isham, Contracts Supervisor
SUBJECT: Intergovernmental Transfer of Public Funds: Voluntary Rate Range Program
RECOMMENDATION
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Approve and authorize Agreement No. 250435B with the California Department of Health Care Services (DHCS) for the Intergovernmental Agreement Regarding Transfer of Public Funds for the term January 1, 2024 through June 30, 2027 for the transfer of approximately $2,000,000 to fund the non-federal share of Medi-Cal Managed Care actuarially sound capitation rates, which includes the 20% assessment fee retained by DHCS. (Fiscal Impact: $2,000,000 Revenue; Health and Human Services Agency Fund; Budgeted; Discretionary)
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BACKGROUND
The Intergovernmental Transfer (IGT) process is a funding mechanism under Section 1903(w)(a) of the Social Security Act, which states and local governments utilize, under certain circumstances, to obtain additional federal matching dollars for Medicaid programs. These funds become available when the State claims federal funds for use in the California Medi-Cal system at a level that is less than the maximum allowable federal funding level. The difference between the maximum allowable federal funding level and the actual amount drawn down by the State is referred to as “headroom.” This “headroom” of unused federal reimbursement is available to be drawn down by counties and other public entities through an IGT. Partnership HealthPlan of California (PHC) and Kaiser Foundation Health Plan are the County’s organized health systems that provide managed health care services for low-income individuals and families eligible for Medi-Cal in Napa and are the fiscal intermediaries for the IGT process to increase federal Medicaid funding available to Napa County. The County’s Health and Human Services Agency (HHSA) has participated in the IGT process since Fiscal Year 2013-2014 and the funding has made possible programs that improve access to services and address service gaps or shortfalls by enhancing, expanding or otherwise supporting health-related services that are not already funded under the Medi-Cal system for Napa County residents. This funding was anticipated and accounted for in HHSA’s overall revenue projections for FY25-26.
FISCAL & STRATEGIC PLAN IMPACT
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Is there a Fiscal Impact? |
Yes |
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Is it currently budgeted? |
Yes |
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Where is it budgeted? |
Health and Human Services Agency, Behavioral Health Division |
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Is it Mandatory or Discretionary? |
Discretionary |
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Discretionary Justification: |
This action is discretionary in that there is no mandate to participate in the Intergovernmental Transfer (IGT) process nor to accept additional federal Medicaid funds made available through the IGT process. However, the IGT process will provide funding for health care programs and activities benefiting Napa County residents. |
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Is the general fund affected? |
No |
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Future fiscal impact: |
This agreement terminates on June 30, 2027 and is included in the requested Fiscal Year 2025-2026 budget. |
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Consequences if not approved: |
If this agreement is not approved, the County will lose the opportunity to obtain additional Medicaid funding. |
ENVIRONMENTAL IMPACT
ENVIRONMENTAL DETERMINATION: The proposed action is not a project as defined by 14 California Code of Regulations 15378 (State CEQA Guidelines) and therefore CEQA is not applicable.