Agenda Item   



                                                                                                                        ASR Control  23-000912




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):

Regina Chinsio-Kwong (714) 834-2729 



Debra Baetz (714) 834-2830



Subject:  Intergovernmental Transfer Opportunity to Support Public Health Initiatives


      ceo CONCUR

County Counsel Review

Clerk of the Board


Approved Agreement to Form




3 Votes Board Majority




    Budgeted: Yes

Current Year Cost:   $4,000,000

Annual Cost: N/A




    Staffing Impact:


# of Positions:            

Sole Source:   No

    Current Fiscal Year Revenue: N/A

   Funding Source:     GF: 100%

County Audit in last 3 years: No

   Levine Act Review Completed: N/A


    Prior Board Action:         12/7/2021 #15, 10/6/2020 #11, 7/16/2019 #12, 7/17/2018 #21






Approve the Intergovernmental Agreement Regarding Transfer of Public Funds with the California Department of Health Care Services for the transfer of approximately $4,000,000 from the Health Care Agency to the California Department of Health Care Services.



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



Direct the Auditor-Controller, upon notification from the Health Care Agency Director or designee to issue payments as required for the Intergovernmental Transfer.








Approval to participate in an Intergovernmental Transfer will result in federal 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 the service period of January 1, 2022, to December 31, 2022. 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. HCA plans to return to your Honorable Board of Supervisors (Board) for approval of the corresponding Agreement with CalOptima related to this IGT once the Agreement with DHCS is finalized.


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. The Board approved HCA's participation in these IGTs for the following periods:


Board Date

IGT Participation Periods

April 26, 2016

Fiscal Year: 2014-15

May 9, 2017

Fiscal Years: 2015-16, 2016-17

July 17, 2018

Fiscal Year: 2017-18

July 16, 2019

Fiscal Year: 2019-20

October 6, 2020

Period: July 1, 2019 - December 31, 2020

December 7, 2021

Period: January 1, 2021, to December 31, 2021


Pending the Board's approval, in FY 2023-24, HCA will transfer the investment amount determined by CalOptima and currently estimated to be $4 million (HCA's original investment) to DHCS. Upon receipt, DHCS will draw down available federal matching funds from CMS and transfer the full match to CalOptima. CalOptima will return HCA's original investment and then CalOptima and HCA will split the federal matching funds. HCA estimates an additional $7 million in federal matching funds above the original investment of $4 million for a total return of approximately $11 million.


Because this federal funding is intended to offset Public Health expenditures, all funds received by both CalOptima and HCA will be used to support Public Health initiatives in Orange County. CalOptima's portion will be used to support priorities of the Orange County Health Improvement Plan that are consistent with their strategic priorities, such as improving access to medical and behavioral health care and improving children’s health, particularly around reducing obesity. Funds received by HCA will offset net County costs to support Public Health Services that promote health and prevent the spread of communicable diseases.


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







Appropriations and revenue related to this IGT are included in Budget Control 042 FY 2023-24 budget.


The transfer amount of approximately $4 million in General Funds in FY 2023-24 will be returned with the estimated $7 million in federal matching funds for a total return of $11 million. Based on prior history, it is estimated that the funds will be returned within 90 days of transfer.












Attachment A - Intergovernmental Transfer Agreement