TO: Board of Supervisors
FROM: Jennifer Yasumoto, Director of Health and Human Services Agency
REPORT BY: Summer Isham, Contracts Supervisor
SUBJECT: Agreement with Kaiser Foundation Health Plan, Inc., related to Intergovernmental Transfer of Public Funds (IGT)
RECOMMENDATION
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Approve and authorize Agreement No. 260060B with Kaiser Foundation Health Plan, Inc., for the term upon approval through June 30, 2026, and subsequent automatic renewals, to provide Medi-Cal managed care capitation rates as a result of intergovernmental transfers from Napa County to the California Department of Health Care Services and to maintain the availability of health care services for Napa County beneficiaries. (No Fiscal Impact)
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BACKGROUND
Since January 1, 2024, Kaiser Foundation Health Plan, Inc., has contracted with the Department of Health Care Services (DHCS) to deliver managed health care services for low-income individuals and families eligible for Medi-Cal across thirty-two counties, including Napa. Kaiser serves approximately 20% of the Medi-Cal population in Napa County, while the remaining 80% is covered by Partnership HealthPlan. This agreement outlines the process for Kaiser beneficiaries to access health care services provided by Napa County, enabling the county to access Kaiser's managed care capitation rate increases through the Intergovernmental Transfer (IGT) process.
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.
The County’s Health and Human Services Agency (HHSA) has participated in the IGT process since Fiscal Year 2013-2014 with Partnership Health Plan and the funding has made possible new 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 agreement allows Kaiser to pass through additional federal Medicaid matching funds to Napa County to enable the County to provide health care services to Napa County residents.
This Agreement will not generate additional revenue for HHSA, as the Medi-Cal population remains unchanged but is now managed by two different plans.
Requested Action:
1. Approve and authorize Agreement No. 260060B with Kaiser Foundation Health Plan, Inc., for the term upon approval through June 30, 2026, and subsequent automatic renewals, to provide Medi-Cal managed care capitation rates as a result of intergovernmental transfers from Napa County to the California Department of Health Care Services and to maintain the availability of health care services for Napa County beneficiaries.
FISCAL & STRATEGIC PLAN IMPACT
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Is there a Fiscal Impact? |
No |
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Is it Mandatory or Discretionary? |
Discretionary |
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Discretionary Justification: |
This agreement arranges for Kaiser Foundation Health Plan beneficiaries to access health care services provided by Napa County, which then allows Napa County to access Kaiser's managed care capitation rate increases through the Intergovernmental Transfer (IGT) process. |
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Is the general fund affected? |
No |
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Consequences if not approved: |
Without this agreement Napa County would be unable to participate in the IGT process, which would result in a loss of revenue. |
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.