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Financing Mechanism Workgroup Ron Robinson, Chair.

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Presentation on theme: "Financing Mechanism Workgroup Ron Robinson, Chair."— Presentation transcript:

1 Financing Mechanism Workgroup Ron Robinson, Chair

2 Reminder: Workgroup Charge To quantify current costs for uninsured adults, to assign cost estimates to various expansion models and to provide recommendations for financing adult health care expansion

3 Two Pronged Approach 1. Current and Future Financing for Care to the Uninsured 2. Determining the Ranges of Cost for San Mateo Specific Expansion

4 Current and Future Financing for Care to the Uninsured

5 Current Cost of Care to the Uninsured Cost of Care (range based on data differences) San Mateo Medical Center (incl. WELL) $48 million to $53.6 million Private Hospitals$12.7 million Free and Community Clinics$6.1 million GRAND TOTAL$66.8 million to $72.4 million

6 Current Funding for Care to the Uninsured Funding sources dedicated to health care for the uninsured (2005)  Realignment: $21,441,052  Required County Match: $6,786,043  County Over-Match: $8,385,171 (FY 03-04)  Prop 99: $442,223  SB 12/Maddy: $1,136,905  Net DSH: $4,857,775  Tobacco Settlement: $7,645,903 TOTAL: $50,695,071 Source: CDHS, OCHS, San Mateo County Health Dept., CA Attorney General

7 Potential Revenue Generation for Care to the Uninsured a) Under the Legal Powers of a County Entity  Mandated Participation  Voluntary Participation b) Requiring State/Federal Legislative Changes to Enact

8 Potential Revenue Generation Voluntary Participation Charge Patient Differential at Point of Service as Incentive to Purchase Individual Coverage Offer Product for Businesses to Participate/Individuals to Participate

9 Potential Revenue Generation Mandated Participation Options Consolidate and Expand Health Care District Tax Charge Differential at Point of Service Increase Licensing Fees Transient Occupancy Tax/Lodging Tax Parcel Tax Increase Sales Tax Business License Tax

10 Potential Revenue Generation Requiring Legislative Change Federal Demonstration Waiver for Local Expansion Legislation Allowing Counties to Impose a Payroll Tax Legislation Allowing Provider Tax/Services Tax Legislation Allowing Mitigation Fee for Businesses/Free Rider Fee

11 Initial Financing Concept The County The Community  Hospitals and Health Care Districts  Businesses  Tax/Fee Individuals

12 Uninsured Adult ??? Employer Offers HPSM Subsidized Insurance Product Adult Covered through New Program Working w. Employer Sponsor Uninsured Adult Not Working or Working w/o Employer Sponsor Uninsured Adult YN Adult Covered through New Program Adult Insured through HPSM Subsidized Insurance Product Below 400% FPL? Y N Individual Offered HPSM Insurance Product Y Employer Offered HPSM Insurance Product Expansion Funding Sources/ Flow Option I

13 Costs of San Mateo Adult Coverage Expansion

14 Coverage versus Insurance Medi-Cal Share of Cost County Mental Health Medi-Cal and Aim for Pregnant Women Family PACT 340B Drug Pricing County Drug Treatment Medi-Cal Limited Coverage

15 Cost-Sharing Analysis Survey of 400 Uninsured Adults  Spanish, Mandarin, English  Health Care Settings, CHI Outreach Sites, Churches and Community Events Intended to Determine Cost-Sharing Amounts for Uninsured Adults

16 Working with an Actuary Three Models Sent to an Actuary Requested Several Cost-Estimates Will Return Estimates in April Refine and Adjust Assumptions

17 Next Steps Joint Meeting of Model and Financing Workgroups Actuarial Estimates Returned Revenue Generation $$ Estimates Focus Groups with Business Community Client Cost Sharing Analysis Completed

18 County Counsel Analysis Mitigation Fee Payroll Tax Health Officer Authority

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