ACE Program
The San Mateo ACE Program is Not Insurance
As noted above, the San Mateo ACE Program is funded under California’s Coverage Initiative, which was designed to promote innovative health coverage programs for uninsured adults. As a Coverage Initiative program, the San Mateo ACE Program is not designed to be insurance. While it offers a coordinated system of care for eligible participants similar to managed care, it does not offer many of the protections available under an insurance product, and State managed care insurance requirements do not apply.
Instead, the San Mateo ACE Program serves as the payer of last resort. If other coverage programs or responsible parties exist for a rendered benefit, the San Mateo ACE program will not be liable. The “coverage” model, as opposed to an “insurance” model, allows for such shared responsibility and thereby maximizes external funding streams that would otherwise not be available to San Mateo County residents.
Specific examples of other coverage programs and other responsible payers include, but are not limited to:
- Family PACT, which provides coverage of family planning services;
- Medi-Cal, which provides health care coverage when an eligible participant becomes pregnant;
- Private hospitals, which provide emergency room and inpatient hospital services under their charity care requirements.
These programs and payers are responsible for providing their respective scope of services to the low-income population that qualifies for the San Mateo ACE Program. When services are either available through these coverage programs, or when they are provided by other responsible parties, coverage will not be available under the San Mateo ACE Program.
In addition, the San Mateo ACE Program is limited in scope with respect to some of the benefits it offers and the provider network available to eligible participants. See the other links for more information.