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Executive Office

Federal Health Care Reform Implementation


On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act (ACA), also referred to as Health Care Reform (HCR). The health reform legislation includes new provisions that expand access to the uninsured, improve outcomes, and reduce healthcare’s overall cost. Measures implementing the federal legislation have rolled out since the bill’s passage in 2010 and will continue to be implemented through 2015.  Several major provisions will become effective January 1, 2014, including the establishment of the state health insurance exchange and the state Medicaid (Medi-Cal) expansion.

When the ACA takes full effect, it is estimated that approximately one million more people will be eligible for Medi-Cal by expanding coverage to adults of up to 138% of the federal poverty level. The Governor’s proposals for Medi-Cal expansion will have significant implications for the manner in which County health programs are administered and for Mendocino County as a whole.

Beginning in January 2014, the State of California is mandated to implement provisions of the ACA. On January 24, 2013, Governor Jerry Brown called an Extraordinary Session of the California State Legislature to address this implementation of Health Care Reform and Medi-cal Expansion in California. Key issues implementing the ACA include:

  • Health Coverage Mandate – Nearly all U.S. citizens and legal residents will be required to have qualifying health insurance coverage or pay a tax penalty;
  • Health Insurance Exchanges –  Exchanges will be run by states, the federal government, or through a federal-state partnership; and
  • Medicaid Expansion – The June 28, 2012 U.S. Supreme Court decision effectively allows states to decide whether or not to expand Medicaid (Medi-Cal).

To begin work on implementation, the Mendocino County Executive Office formed an internal County Health Care Reform Working Group shortly after the Governor called the Extraordinary Session of the Legislature, comprised of the following departments:

  • Executive Office
  • Human Resources
  • Health and Human Services Agency (HHSA)
  • Child Support Services
  • County Counsel

Impacts to County of Mendocino

Health care reform, when implemented, will impact health benefits provided to our employees and their dependents, will impact services to clients of the Health and Human Services Agency and Child Support Services, and will affect State and Federal funding streams.

The internal County HCR Working Group has identified potential areas for heightened risk exposure, including:

  • Impacts to the County-run health plan;
  • Managing utilization of extra-help employees with regard to employee benefits;
  • Administration of health programs for new eligibles;
  • New training/legal requirements for Medi-Cal eligibility workers in HHSA;
  • Expanded county behavioral health responsibilities; and
  • Impacts to Child Support Services clients.

There are numerous potential challenges and “known unknowns” that could arise for Mendocino County during the implementation process over the next nine months.

Employee Health Plan

The County runs its own self-insured health plan, with a 75% County / 25% Employee match. The health plan includes full medical, dental, and vision coverage to its employees. Delta Health Systems serves as the third party administrator for the plan, and the provider network is Anthem Blue Cross. Keenan & Associates serves as the primary healthcare consultant to the self-insured plan.

Retiree Transition to Health Exchange

The County currently provides health coverage to forty-eight non-Medicare-eligible retirees and twelve dependents. The County pays approximately 28% for retirees’ monthly premiums. This coverage will end on December 31, 2013, and is expected to be replaced by either Covered California or Medi-Cal, depending on the personal preference or financial ability of these particular retirees. The County is currently providing updates to these retirees on their health care options, based on information received from California’s health benefit exchange, Covered California.

Medi-Cal Expansion

In order to implement the Medi-Cal expansion, Governor Brown has proposed two options: a state-based approach and a county-based approach. Under the state option, the state would offer a benefit package similar to what is currently available through Medi-Cal and assume the long term responsibility for costs of this program. The Governor has proposed that counties assume new human services responsibilities and costs (such as subsidized child care) and use “savings” from Medi-Cal’s assumption of medically indigent adults in the program.

Under the county option, the Medicaid expansion would be built on existing low income health programs, such as the County Medical Services Program (CMSP) and counties would maintain fiscal and operational responsibility for covering the indigent adult population. Counties would also be required to comply with new statewide requirements for eligibility and benefits.

The California State Association of Counties (CSAC) and the CMSP Governing Board have taken positions in support of a state-based expansion, but do not support the Governor’s proposed realignment.  Rather these organizations support reinvesting savings into prevention programs that would reduce costs over the long term.

Presentation to the Board of Supervisors (April 9, 2013)

Agenda Summary

Staff Report

Presenter Outline

Working Group Members

Presenter Biographies

Stakeholder Announcement

Presentation: Lee Kemper, Kemper Consulting Group

Presentation: Peter McNamara, Keenan & Associates

Presentation: Lynn Scuri, Partnership HealthPlan of California

Kaiser Family Foundation HCR Overview

Legislative Analyst Office (LAO) Report on Medi-Cal Expansion

California State Association of Counties (CSAC) Policy Principles, Analysis, Etc.

County Health Plan Resources

Next Steps

Members of the HCR Working Group, and Supervisor Carre Brown, the Board Representative to CSAC, are actively engaged in preparing for HCR, such as participation in their respective State associations, attending statewide policy briefings, monitoring legislative developments, and regulatory/compliance briefings. 

Regular updates on local implementation measures will be included in the published CEO Reports, available here.

Dates of Interest

Spring/Summer - California Legislature - Extraordinary Session and associated Legislative hearings

May, 2013 - Governor Brown releases the May revision to the State Budget

Late Summer - Board of Supervisors action on County Health Plan (prepare for open enrollment)

Fall 2013 - California Covered Open Enrollment

November/December 2013 - Employee Health Plan Open Enrollment Period

January 1, 2014 - HCR implementation in effect

Links/Website Resources

Various resources pertaining to HCR implementation are listed below:

Local Resources

Chief Executive Officer Reports

County Employee Human Resources HCR information

County of Mendocino Employee Benefits (County Health Plan)

Delta Health Systems - HCR Resources

Keenan & Associates HCR Information

State Resources

Governor Brown's Proclamation

California State Legislature

California State Association of Counties

Covered California

California Health Benefit Exchange

Partnership Health Plan of California

Federal Resources

National Association of Counties (NACO) Member Resources

Kaiser Family Foundation HCR Overview

Federal Health Care Resources

Centers for Medicare and Medicaid Services

Contact Information

Questions or comments may be directed to the Mendocino County Executive Office at: ceo@co.mendocino.ca.us or by calling 707-463-4441.


Created: April 9, 2013

Last Updated: April 10, 2013

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