Agenda Item   



                                                                                                                        ASR Control  19-000893




legal entity taking action:

Board of Supervisors

board of supervisors district(s):

All Districts

SUBMITTING Agency/Department:

Health Care Agency   (Approved)

Department contact person(s):

Marc Meulman (714) 834-2980 



David Souleles (714) 834-3882



Subject:  Intergovernmental Transfer Agreement


      ceo CONCUR

County Counsel Review

Clerk of the Board


Approved Agreement to Form




3 Votes Board Majority




    Budgeted: N/A

Current Year Cost: N/A

Annual Cost: N/A




    Staffing Impact:


# of Positions:

Sole Source: N/A

    Current Fiscal Year Revenue: N/A

  Funding Source: N/A

County Audit in last 3 years: No



    Prior Board Action: 07/16/2019 #12






Approve the Intergovernmental Transfer Agreement with the Orange County Health Authority dba CalOptima for participation in an Intergovernmental Transfer to obtain federal reimbursement for uncompensated care provided to their patients July 1, 2018, through September 30, 2021.



Authorize the Health Care Agency Director, or designee, to execute the Agreement referenced in Recommended Action No. 1.







Approval to participate in an Intergovernmental Transfer will result in the reimbursement for uncompensated health care provided to Medi-Cal patients.






Rate range Intergovernmental Transfers (IGT) began statewide in 2006 and have been used by other counties in California to offset the cost of uncompensated health care provided by county health departments, public hospitals and other local care providers. The federal Centers for Medicare and Medicaid Services (CMS) provides a rate range for Medi-Cal managed care services, but the actual reimbursement rates that plans receive are set by the California Department of Health Care Services (DHCS). The difference between the federal allowable rate and state actual rate represents the potential amount of federal reimbursement that counties can claim through a rate range IGT. The Health Care Agency (HCA) was invited by the Orange County Health Authority dba CalOptima (CalOptima) to participate in an IGT to obtain federal reimbursement for uncompensated health care provided to their patients during FY 2018-19. The reimbursement by CMS is a dollar for dollar match of non-federal funds, which combined covers the cost of eligible healthcare expenditures incurred. In this instance, the net proceeds are shared between CalOptima and HCA.


CalOptima, in collaboration with the University of California, Irvine Medical Center, has participated in IGTs since FY 2010-11. To optimize Orange County's drawdown of federal funds, CalOptima extended the IGT opportunity to HCA beginning with FY 2014-15. On July 16, 2019, your Honorable Board of Supervisors (Board) approved HCA’s IGT Agreement with DHCS, which authorized HCA to transfer approximately $3.2 million to the state. Approval of this Agreement with CalOptima will allow CalOptima to transfer to HCA the estimated $3.1 million in federal matching funds for a total return of approximately $6.3 million, as specified in the Agreement with DHCS approved by the Board on July 16, 2019. The state agreement was brought to the Board on July 16, 2019, to meet the July 31, 2019, deadline required by DHCS. The CalOptima agreement referenced in the recommended action was not received in time to include with the state agreement approved on the July 16, 2019.


Because this federal funding is intended to offset Public Health expenditures, all funds received will be used to support Public Health initiatives in Orange County. Funds received by HCA will offset net County costs to support Public Health Services that promote health and prevent the spread of communicable diseases.


The term of the Agreement with CalOptima references a start date of July 1, 2018, to correlate with the time period available for the IGT. No funds will be transferred from CalOptima to HCA until this agreement is fully executed.


The Agreement with CalOptima contains a mutual indemnification provision, which varies from the County's standard of sole indemnification, thereby obligating both parties to indemnify, defend and hold harmless each other from all third party claims and liabilities arising from the parties' performance of the IGT Agreement. CEO/Office of Risk Management has reviewed and approved this provision and determined the risk to be acceptable for the County's obligations under the Agreement.


HCA requests approval of the IGT Agreement with CalOptima and associated actions referenced in the Recommended Actions.

















Attachment A - Intergovernmental Transfer Agreement with the Orange County Health Authority dba CalOptima
Attachment B - Risk Assessment Form