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Fresno Rejects a Federal Match Under the Low Income Health Program

Fresno County’s Low Income Health Program (LIHP) application stated that it would put up $56M ($28M/year) to cover 12,000 Medically Indigent Adults (MIAs) under 114% FPL for two years, starting January 1, 2012. Yesterday, the Fresno County Board of Supervisors voted against drawing down a federal match. The reason, they stated, was due to a 30-year contract with Community Medical Centers (CMC) to manage the Medically Indigent Services Program (MISP), their current program for MIAs. The contract is in its 15th year.

Under the contract, Fresno County pays CMC $20M annually to care for uninsured residents. This care does not include primary care and care is restricted to CMC facilities. Drawing down federal funds would require the County to commit $18M of the $20M currently provided to CMC each year to LIHP (in addition to $10M from mental health realignment for a total of $28M/year).CMC currently provides care for 18,000 MIAs, approximately 6,000 of whom are undocumented.

Fresno County concluded that they could not support their current contract with CMC while also providing funding for LIHP. The refusal to participate in LIHP could jeopardize the county’s ability to enroll newly eligible individuals into Medi-Cal when care for that particular population is fully funded by the federal government in 2014.

Fresno is the only county in California to turn down the matching funds under the §1115 Waiver. Some counties might limit enrollment due to high anticipated treatment costs. The waiver requires counties to offer a core set of benefits, including mental health, physician services, and prescription drugs. It also sets strict timely access standards, such as offering primary care appointments within 20 days, urgent care within 48 days, and specialty care within 30 business days, and geographic access standards, such as ensuring that a primary care provider is within a maximum of 30 miles or 60 minutes from the subscriber.

If fully implemented, LIHP could offer coverage to approximately 500,000 low-income Californians.

Read more here.