(A) The purpose of the Commission is to negotiate exclusive contracts with the California Department of Health Care Services and to arrange for the provision of health care services to qualifying individuals in Santa Cruz County, Monterey County, Merced County, San Benito County and Mariposa County who lack sufficient annual income to meet the cost of health care, and whose other assets are so limited that their application toward the cost of health care would jeopardize the person or family's future minimum self-maintenance and security, pursuant to Chapter 7 of Part 3 of Division 9 of the Cal. Welfare and Institutions Code.
(B) The Commission shall design and operate a program that:
(1) Delivers primary care via a contracted provider network which significantly improves access to primary care and related specialty and ancillary services for enrolled Medi-Cal recipients;
(2) Includes mechanisms for ensuring that Commission-financed medical care services meet appropriate quality of care standards;
(3) Incorporates a plan of service delivery and implements reimbursement mechanisms which will promote the long-term viability of a locally operated Medi-Cal managed care system and participating "safety net" providers herein defined as Medi-Cal disproportionate share hospitals, county clinics and licensed community clinics;
(4) Implements a financial plan which includes the creation of a prudent reserve within three years of commencing operations, and which provides that if additional surplus funds accrue, they shall be used to expand access, improve benefits and augment provider reimbursement;
(5) Gives a high priority to increasing prevention, education, and early intervention services for enrolled recipients;
(6) Ensures that all program obligations, statutory, contractual or otherwise, shall be the obligations of the program and shall not be the obligations of Santa Cruz County, Monterey County, Merced County, San Benito County, Mariposa County or the state; and
(7) Implements programs and procedures to ensure that a high level of member satisfaction is maintained.
(C) The Commission shall also be authorized to contract with public insurers, payors or plan sponsors to offer and/or administer their health care programs, and to contract with private insurers or plan sponsors to administer their health care programs.
(Ord. 1033, § 1, 2021)