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Home My WebLink AboutMINUTES - 01221985 - 2.1 -21/ 1. HE BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Adopted this Order on _ January 22_ 1985by the following vote: AYES: Supervisors Powers , Schroder , Torlakson. NOES: None. ABSENT: Supervisors Fanden, McPeak. ABSTAIN: None. SUBJECT: Standards for Administration ) of the Basic Adult rare Program ) RESOLUTION 85/35 WHEREAS the State of California eliminated the Medi-Cal Medically Indigent Adult Program effective January 1, 1983; and WHEREAS the State has allocated funding to Contra Costa County for health care services to individuals eligible under the State's NI*edically Indigent Adult Program standards (MIAs); and WHEREAS the County is responsible under Welfare and Institutions Code Section 17000 for the health care of persons qualified as indigent for its General Assistance program; and WHEREAS the County established the Basic Adult tare program by Resolution 82/1486, superseded by Resolution 83/191 as amended by Resolution 83/1025; The Contra Costa County Board of. Supervisors hereby adopts the following standards for administration of the Basic Adult Care program, effective January 1, 1985: I. Basic Adult Care Program. The Basic Adult Care program (BA('-) is health care service provided to eligible individuals under the County's contract with the Contra Costa Health Plan. The BAC program is the County health care program for the General Assistance eligibles described herein. II. Eligibility. A. The following persons are eligible for the Basic Adult Care program: Legal residents of Contra Costa County who are age 21 or over but under age 65 who would be eligible for medical services under the Medi-Cal Medically Indigent Program but for the fact that they are neither a woman with a confirmed pregnancy nor persons confined in a skilled nursing or intermediate care facility, including persons eligible for Contra Costa County General Assistance as determined by the Social Service Department under Resolution No. 83/1008, who are age 21 or over but under age 65. Oflg: Ot;pt.: health Services cc: County Counsel -1- RESOLUTION NO. 85/ 35 (� r B. Three month limitation 1. A determination that a person is eligible for Basic Adult Care program benefits is effective only for three calendar months, including the month during which application is made. Upon the termination of eligibility the person must re-apply and eligibility must be re-deter miend. When eligibility has terminated, further application may not be made and shall not be considered, until the applicant next needs health care services under the Basic Adult Care program, and applies at a Contra Costa County Health Services Department facility. 2. A person whose eligibility period ends while that person is hospitalized in the County Hospital shall be deemed to have reapplied, and, if the person still satisfies the eligibility criteria, will be granted a consecutive three-month period of eligibility. 3. An applicant shall be entitled to receive medically necessary services at a Contra Costa County Health Services Department facility before eligibility has been determined. If the applicant who has received medical services is determined to be ineligible, the Health Services Department shall bill the applicant directly for the services rendered. 4. The eligibility of persons entitled to receive Basic Adult Care program services upon the date this Resolution is adopted shall terminate and become subject to the re-application and re- determination requirements, as follows: a. For persons who have been entitled to receive Basic Adult Care program services for three months or more, eligibility terminates on February 28, 1985. b. For persons who have been entitled to receive Basic Adult Care program services for less than three months, eligibility terminates on March 31, 1985. C. Eligibility Determination MIA eligibility will be determined, and General Assistance eligibility will be verified, by the Health Services Department. For those persons subject to a Medi-Cal Share of Cost, gross income and family size shall be used to determine the amount of the monthly Health Partnership to be paid. III. Enrollment in HMO Persons who are eligible for the Basic Adult Care program will be enrolled in the Contra Costa health Plan for the term of the period of eligi- bility which has been established under the provisions of section II, and are subject to termination as provided in the County's contract with the Plan. The County, through ft.� Health Services Department, will pay the Contra Costa Health Plan such membership fees as are established by contract between the County and the Healtb flan. 'tie. Contra Costa Health Plan will authorize the provision of services by nark-Plar_ providers and authorize payment for such services only if the PAC'-el; il7'fc 5V*s6ts M enrolled in the BAC Group of the Health Plan and the HelfhIaii Nitidici T i*ector or a designee has determined that it is medically appr8prisfp ti-itLt thy' A.C.bGroup Member receive those services from a non-Plan -2- RESOLUTION NO. 85/ 35 \O l TV. Services Provided The services provided under the Basic Adult Care program shall be limited to the basic health services required of a federally qualified health maintenance organization pursuant to Title XIII of the Social Security Act plus medically required prescription drugs. V. Health Partnership Payments. A. Health Partnership Obligation: Individuals otherwise qualified under Part II.A.1. for the BAC Program who are determined by the Health Services Department to be able to contribute, based on income and resources, to the cost of their health care will be required as a condition of eligibility to pay a proportionate share of their Health Plan monthly cost. Said proportionate share shall be no less than $25 and no more than $75 per month and shall he based on each eligible's gross income and family size. B. Payment of the Health Partnership obligation: 1. Persons subject to a Health Partnership obligation will be enrolled in the Contra Costa Health Plan - Basic Adult Care Group, advised of their financial obligation and asked to make payment for their three (3) month eligibility period upon approval of their application. 2. Persons who do not pay the entire amount of the obligated Health Partnership in advance, must pay the remainder by the first day of the following month. 3. Persons who fail to make timely payment of their Health Partnership obligation are subject to disenrollment from the Basic Adult Care program effective as of the date of eligibility after notice and informal hearing with a Financial Counselor. 4. Persons with an unpaid Health Partnership obligation under the Basic Adult Care program are ineligible for re-enrollment upon the expiration of their three month eligibility period. VI. Choice of Program. Eligible persons who choose not to participate in the County's Basic Adult Care program will not be enrolled in the Contra Costa Health Plan and will be treated by the County as private pay fee-for-service patients. The County will not pay for care provided to such fee-far-service patients at non-County facilities. 1I. Regulations. The County Health Services Director is empowered to adopt written regu- lations and procedures consistent with this Resolution for the operation of the Basic Adult Care program. Resolutions 82/1486, 83/191, and 83/1025 are hereby superseded. Ittereby certify that this is a true and correctcopy of an action taken and entered on the minutes of the Board of Supervis rs on the date shown. ATTESTED: 6015 PHIL BAT HELOR, Clerk of t9e Board of Supervisors and County Administrator By , Deputy RESOLUTION NO. 85/35