HomeMy WebLinkAboutMINUTES - 06251985 - 1.99 THE BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
Adopted this Order on June 25, 198 , by the following vote:
AYES: Supervisors McPeak, Schroder, Torlakson, Fanden.
HOES: None.
ABSENT: Supervisor Powers
ABSTAIN: None.
SUBJECT: Standards for Administration )
of the Basic Adult Care Program ) RESOLUTION 85/376
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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 Medically 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 Care program by Resolution
82/1486, superseded by Resolution 83/191 as amended by Resolution 83/1025; and
superseded these Resolutions by Resolution 85/35 as amended by Resolution
85/114;
The Contra Costa County Board of Supervisors hereby adopts the following
standards for administration of the Basic Adult Care program, effective
July 1, 1985:
I. Basic Adult Care Program.
The Basic Adult Care Program (BAC) 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.
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RESOLUTION NO. 85/376
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' B. Term of Eligibility:
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1 . The Health 3orviooa Director, by regulation, shall
determine and may modify the term of eligibility of persons entitled
to receive Basic Adult Cure. 8 determination that a person is
eligible for Basic Adult Care program benefits shall be effective
for not less than three calendar months, including the month
during which application is made, provided that at all times during
such period such person meets the eligibility requirements which
are expressed in Part ZI.A and fulfills the Health Partnership
obligation, if any, in accordance with the provisions of Part V.B.
The Health Services Director may, by regulation, establish the
terms and conditions under which persona enrolled in the Basic
Adult Care program may be re-enrolled for consecutive eligibility
periods.
2. Upon termination of eligibility the person must
reapply, and his or her eligibility must be redetermined. Neither
an initial application for enrollment nor an application for
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re-enrollment after termination may be made, nor may eligibility be
determined for a person not then enrolled, until the applicant
needs health care services under the Basic Adult Care program and
applies at a Contra Costa County 8aa}tb 3orvi000 Department facility.
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, then the Health Services Department shall bill the
applicant directly for the services rendered.
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 Coat, gross income
and family size nbaII be used to determine the amount of the
monthly Health Partnership to be paid.
III. Enrollment in HMO
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Persons who are eligible for the Basic Adult Care Program will be
enrolled in the Contra Costa 800ltb Plan for the term of the period of
eli8ibllitvwbicb 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 its Health Survloao Department, will pay the
Contra Costa Health Plan such membership 0aeo as are established by contract
between the, County and the Health Plan.
The Contra Costa Health Plan will authorize the provision of services
by non-Plan providers and authorize payment for such aarvioao only if the
BAC-Eligible person is enrolled in the 8&C Group of the BaaItb Plan and the
Health 9Iao Medical Director or a designee has determined that it is medically
appropriate that the 8&C Group Member receive those services from a non-Plan
provider.
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RESOLUTION NO. 85y376
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IV. 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 be 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 not less than the minimum three (3) month
eligibility period upon approval of their application.
2. Persons who do not pay the entire amount of the three month
Health Partnership in advance, must pay the remainder by the
first day of the following month, and must pay any further
obligation as directed by the Health Services Director.
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 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-for-service patients at
non-County facilities.
VII. :Regulations.
The County Health Services Director is empowered to adopt written
regulations and procedures consistent with this Resolution for the operation
of the Basic Adult Care Program.
Resolutions 85/35 and 85/114 are hereby superseded.
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C C • County Administrator I hereby certify that this is a true an-!-^fres'ccpy of
Health Services Director an action taken and entered on th: :::mules of the
Contra Costa Health Plan Board of Supervis -s on the dare �thovin.
Count Counsel �'
County ATTESTED:
Social Services PHIL Bf. 1i LLP. Board
Of Su/p!cC.MZCrc C,-,d COL'ii a Administrator
By
`� l , Deputy
RESOLUTION 85/376