Important note: the following recommendation was approved by the Board of Supervisors on Dec. 13, 2016:

To:              Honorable Board of Supervisors

From:         Louise Rogers, Chief, Health System; Chester J. Kunnappilly, MD, Chief Executive Officer, San Mateo Medical Center; Cassius Lockett, Director, Public Health, Policy and Planning; Stephen Kaplan, Director, Behavioral Health and Recovery Services

Subject:     Measure K: Approval of Whole Person Care Pilot


Measure K: Adopt resolutions authorizing:

A)     Approval of an Appropriation Transfer Request recognizing $25,884,183 in unanticipated revenue, including $1,000,000 from Measure K, and making corresponding appropriations of $25,884,183 in the Public Health, Policy and Planning, Behavioral Health and Recovery Services, and San Mateo Medical Center budget units to provide an Intergovernmental Transfer and related expenditures for the Whole Person Care pilot authorized by the Department of Health Care Services under the Medi-Cal 2020 waiver; and

B)     Approval of the allocation of $1,000,000 for FY 2016-17 and $2,000,000 per fiscal year, ongoing, for the term of the Whole Person Care pilot from Measure K funds for housing services; and

C)     Adoption of a Salary Resolution adding 15 permanent positions to staff the pilot.


California’s 1115 Medicaid Waiver Renewal, called Medi-Cal 2020, was approved by the Centers for Medicare and Medicaid Services to transform the healthcare delivery system. The Whole Person Care (WPC) pilot is aimed at improving the quality of care, access, and efficiency, within five years for the WPC target population. This memorandum follows up your action on November 1, 2016 that authorized the Chief of the Health System to sign the WPC pilot agreement with the California Department of Health Care Services (DHCS) after San Mateo County’s WPC application being approved.

WPC pilot funds will be used to establish the culturally competent patient engagement, activation, care management, and support strategies necessary for complex Health System “High Utilizers (someone who uses the emergency room more than four times per year)” facing substantial barriers to connect with needed medical, social, and housing services. Ultimately, WPC will improve patients’ health and well-being through more efficient and effective use of resources that are not covered by Medi-Cal.


In order for the pilot to successfully provide services to the target population, the WPC pilot will expand the following programs: 1) Integrated Medication Assisted Treatment (IMAT), which assists clients with substance use disorders; the Health Plan of San Mateo’s (HPSM) Community Care Settings Pilot, which assists clients within complex care and housing needs; 3) Collaborative Care Team, which assists clients in locked facilities to move back into community settings; 4) Homeless Outreach Team, which assists homeless clients; and 5) Bridges to Wellness Team (formerly the Street and Field Medicine Team), which assists clients who over-utilize emergency departments and are living on the streets and in shelters. Partners in the WPC pilot include HPSM, the Human Services Agency, and many community-based organizations.

The funding for existing programs will comprise the 50% match required to receive the additional WPC funding. As a result, the total funding for the WPC pilot far exceeds the portion allocated to new WPC services for new clients.

Attached to this memorandum is the salary resolution adding the following 15 permanent positions to execute the WPC work, and the resolution provides for the following fifteen permanent positions:

Job Class Description                                                             Count

Social Work Supervisor


Nurse Practitioner Supervisor


Nurse Practitioner


Ambulatory Care Nurse


Licensed Psychiatric Social Worker II


Health Services Manager II


Management Analyst


Social Worker III


Supervising Mental Health Clinician


Total Permanent Positions


This agreement for the WPC funding, and this resolution have been reviewed and approved by County Counsel as to form.

WPC aims to improve 10 metrics as required by DHCS to demonstrate the  effectiveness of the pilot in improving the outcomes of the WPC enrollees. The metrics measure client health, whether they are getting the services they need, and utilization of services. Each metric will be monitored throughout the pilot and reported on regularly. Baseline data will be submitted at the beginning of program year 2.

This action contributes to the Shared Vision 2025 outcome of a Healthy Community by providing coordinated patient-centered care for San Mateo County residents. It is anticipated that annual enrollment will ramp up to 2,000 clients per year and that 5,000 clients will be served over the entire term of the agreement.



FY 2016-2017 Estimated

FY 2019-2020 Projected

Enrollment in the WPC pilot



Average Emergency Department utilization by participants

4 visits

3 visits


The term of the agreement is January 1, 2016 through December 31, 2020. The annual amount is not to exceed $33,073,542 for the five-year term. The Appropriation Transfer Request increases the FY 2016-17 Budget by $25,884,183. This includes the  accounting transaction for the Intergovernmental Transfer that is required of the grant. Intergovernmental Transfers are the mechanisms that are used to access federal funding through the State to the Federal government. Cash is transferred from the County to the State as a 50% match ($16,536,771), which represents a full year of the grant. Federal funds will then be returned in the amount of $33,073,542. Of this amount,

$16,536,771 is the required match, $9,347,412 has been recognized as unanticipated revenue and recognized through the Appropriation Transfer Request, $4,946,709 has been included in the budget as this revenue replaces the lost funding for the IMAT  team, and $2,242,650 will be placed in reserves should we not meet required performance metrics. Included in the matching funds is $1,000,000 of Measure K funds for the first year and $2,000,000 will be included in future annual budget requests to assist with housing services for our complex clients. The budget for the remaining four years will be included in future budget requests.

Important note: this is a copy of the official report -- item 40 on the Board's agenda.