TO: Board of Supervisors
FROM: Jennifer Yasumoto, Director of Health and Human Services Agency
REPORT BY: Jennifer Ivancie, Staff Services Analyst I
SUBJECT: Agreements for Medi-Cal Administrative Activities for Fiscal Year 2025-2026
RECOMMENDATION
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Approve and authorize Agreement No. 260195B with Puertas Abiertas Community Resource Center; Agreement No. 260196B with Cope Family Center, Inc.; Agreement No. 260197B with UpValley Family Centers of Napa Valley, Inc.; and Agreement No. 260198B with Parents Child Advocacy Network for Fiscal Year 2025-2026 to provide outreach for and linkage to the Medi-Cal program and services as well as facilitate the Medi-Cal application process. (Fiscal Impact: $125,575 Expense; Health and Human Services Agency Fund; Budgeted; Discretionary)
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BACKGROUND
Medi-Cal Administrative Activities (MAA), provided for in the Medi-Cal State Plan and implemented through the 1995 Medi-Cal Administrative Claiming (MAC) agreement, are activities that support the overall Medi-Cal system such as connecting potential individuals to eligibility and services, planning related to system capacity, and general administration. The Medi-Cal State Plan identifies the Department of Health Care Services (DHCS) as the single state agency responsible for administering the federal Medicaid program (Medi-Cal in California) and lays out the eligibility criteria for beneficiaries and services that can be provided. Essentially, every activity and service that is to be claimed for Federal Financial Participation (FFP) must be covered in the State Plan. The Local Government Agency (LGA), or the designated entity responsible for administering MAA locally, is Napa County’s Health and Human Services Agency (HHSA). The LGA may subcontract with Community Based Organizations (CBOs) and other local agencies to perform MAA.
Currently, many CBOs are the first doors that low-income individuals and families enter for services, information, referrals, and facilitation of applications for public assistance. Services such as these may be reimbursable under the MAA program. The CBO's represented in these agreements are well regarded by the communities they serve and are very accessible to the target populations, making them the perfect vehicle to have a positive, proactive impact in reaching the uninsured.
The CBOs will assist HHSA with outreach, enrollment, retention, and utilization for potentially eligible Medi-Cal children/families throughout Napa County. Outreach may consist of discreate campaigns or may be an ongoing activity, such as: sending teams of employees into the community to contact unhoused persons dealing with substance abuse; establishing a telephone or walk-in service for referring persons to Medi-Cal services or eligibility officers; and operating a drop-in community center for underserved populations, such as minority teenagers where Medi-Cal eligibility and information is disseminated. Outreach campaigns will also focus on bringing potential Medi-Cal eligibles to apply for Medi-Cal and into Medi-Cal services.
These agreements are funded with MAA reimbursements that HHSA claims based on MAA claimable activities performed by these CBO's. In order for HHSA to claim the FFP from DHCS, it must expend up-front Certified Public Expenditures (CPE) to pay for the services. CPE is provided by county contributions, the Tobacco Master Settlement Agreement funds (MSA), and Mental Health Services Act (MHSA) grants. These contract maximums represent the costs of providing the services and these agreements will enable the CBOs to continue their Medi-Cal outreach and enrollment efforts.
These agreements are presented late to the Board because they are based on the amount of available Certified Public Expenditure (CPE) which is not known until the end of the fiscal year. The funds used to support the work include MSA, MHSA, and reimbursement received from DHCS for the prior year’s MAA expenditure. The Contract Scope of Work and Compensation cannot be determined until the funding amounts are known.
All agreements are with local vendors.
Requested action:
Approve and authorize the following agreements:
1. Agreement No. 260195B with Puertas Abiertas Community Resource Center for a maximum of $24,807;
2. Agreement No. 260196B with Cope Family Centers, Inc., for a maximum of $16,445;
3. Agreement No. 260197B with UpValley Family Centers of Napa Valley, Inc., for a maximum of $32,323; and
4. Agreement No. 260198B with Parents Child Advocacy Network for a maximum of $52,000.
FISCAL 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 Public Health Division |
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Is it Mandatory or Discretionary? |
Discretionary |
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Discretionary Justification: |
While there is no mandate to contract with these providers, these agreements allow HHSA to continue to support a community-wide effort to outreach and enroll uninsured and potentially eligible residents in the Medi-Cal program and link them to needed health and behavioral health services. |
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Is the general fund affected? |
No |
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Future fiscal impact: |
None, these Agreements terminate June 30, 2026, and are included in the approved Fiscal Year 2025-2026 budget. |
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Consequences if not approved: |
Contractors will be unable to be reimbursed for additional outreach and facilitation of application activities performed in the community and HHSA will be unable to claim the providers’ portions from the agreements that provide outreach and facilitation of application activities, which are reimbursable by Medi-Cal Administrative Activities. |
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Additional Information: |
Strategic Initiative: Compassion & Access |
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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.