San Francisco: LIHP
transitions to ACA coverage
Alice Gleghorn, Ph.D.
San Francisco AOD Administrator
Healthcare Milestones:
• 2005-Mayor Gavin Newsom call for Universal Healthcare
• 2006- SF Health Care Security Ordinance
• Jan 2007- HCCI application submitted
• July 2007-Healthy San Francisco launched
• September 1, 2007- June 30, 2011- HCCI
• July 1, 2011- Dec 31, 2013- LIHP in effect
Healthy San Francisco (HSF)
July 2007
• SF Medical Home-based care, not insurance
• Services in SF for residents 18-64 with income/ assets up
to 500%FPL who are ineligible for public coverage such as
MediCal
• Quarterly Income-based Participant fee & POS fee
• Phased enrollment to reach to 500% FPL
• One-e-App- assess eligibility/enroll in HSF, ID’d HCCI
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Unique Client ID
Preliminary eligibility determination for other public programs
Verification of residency, etc. (document imaging)
Current enrollment status
Rapid renewal process
Routing eligibility to registration and billing
• Initial DPH Service sites (PC, Hospital, CBHS)
• ADDED addt’l PC (N=37) and all hospitals except VAMC
Prior 1115 Waiver - Health Care Coverage Initiative (HCCI)
-HCCI
goal- provide 100,000 uninsured CA adults with
comprehensive care and access to a primary medical home
-Competitive State application -- 10 counties selected
-In San Francisco, HCCI funded Healthy San Francisco
-HCCI reimbursement limited to HSF participants who met
federal criteria:
--Uninsured adult aged 19 – 64
--San Francisco resident
--Income at or below 200% FPL
--2005 Deficit Reduction Act (ID&legal
status)
-San Francisco’s HCCI network-SFDPH (PC, SFGH, CBHS)
-DPH had over 10,000 HSF participants with HCCI-eligibility
-HCCI effective September 1, 2007 to June 30, 2011
New 1115 Waiver - Low Income Health
Program (LIHP)
• California’s “Bridge to Reform” Medicaid 1115
Waiver
• LIHP goal-“expand coverage to low-income
Californians”
• Voluntary County participation in LIHP
– with exception of 10 HCCI counties
• -CA LIHP enrollment goal≈ 500,000 low-income
adults
• Effective July 1, 2011- Dec. 31, 2013
– Timed with January 1, 2014 implementation of
individual mandate under Affordable Care Act
LIHP Eligibility
• LIHP covers individuals who are:
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Between the ages of 19 and 64
U.S. citizens or qualified immigrants
Have U.S. government identification
Residents of the program county
Not pregnant
Not eligible for Medi-Cal or S-CHIP
Between 0% and 200% FPL
2 coverage populations and benefits based on FPL
• Medicaid Coverage Expansion (MCE)- required
– incomes between 0% - 133% FPL
• Health Care Coverage Initiative (HCCI)- optional
– incomes between 134% - 200% FPL
LIHP= SF Path
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SF Provides Access to Health care
Care at DPH Medical Homes
Impact of Ryan White enrollees in LIHP
MCE Restricted to 0-25% FPL
@11,000 enrollees
On 1/1/14- ALL LIHP patients become the
MediCAL newly eligible population
Immediate SF PATH Enrollment Goals
• Target 11,000 uninsured clients in MH/SA
• Also 3,000 uninsured in DPH Healthy SF
– (20,000 HSF at non-DPH medical homes)
• Train 40 new enrollers by next week
• Hold Project Homeless Connect event
• At annual re-enrollment, HSF clients who
are eligible for covered CA or MediCAL are
no longer eligible for HSF and must
change