ACE Program
San Mateo Access and Care for Everyone (ACE) Program:
Important Information for Non-ACE Providers Contracted with San Mateo County for Indigent Care Services
Overview
The San Mateo ACE Program is a program offered by San Mateo County to expand access to care for eligible low-income residents of the county. Funding for this program was made available by the Centers for Medicare and Medicaid Services under California’s 2005 Section 1115 Medi-Cal hospital waiver. This funding was competitively awarded to San Mateo and nine other counties under California’s Coverage Initiative. The San Mateo ACE Program is also serving as a vehicle for piloting recommendations adopted by the Blue Ribbon Task Force on Adult Health Care Coverage Expansion, the group responsible for exploring options for providing comprehensive health care access and/or insurance to low-income, uninsured adults in San Mateo County. San Mateo ACE was launched in September 2007.
San Mateo County has contracted with the Health Plan of San Mateo to provide third-party administrator (TPA) services for the San Mateo ACE Program, effective February 1, 2008. Under this contract, HPSM will provide the following services:
- Claim processing and data management
- Outpatient pharmacy benefit management
- Provider relations
- Utilization and medical management
- Collection of annual participation fee
- Customer service
- Grievance and appeals
- Quality assessment and improvement
- Provision of participant informing materials Reporting
These services are designed to create a coordinated and participant-centered system of care that emphasizes primary and preventive care, as well as management of chronic conditions. Participants will be assigned to a primary care clinic that will serve as a medical home, where they can access a range of outpatient and ancillary services. Services may also be available through other San Mateo ACE Providers, as well as through designated non-ACE providers with referral and authorization.
Funding exists to enroll approximately 4,200 participants in the San Mateo ACE Program at any given time. Participants must meet income, citizenship, and residency requirements, but no asset tests are applied. All participants will be issued a participant identification card by the Health Plan of San Mateo.