Question/Supervisor Diane Burgis: It’s my understanding that they have until January 1st to enroll
if they are not already enrolled, correct? Do they have to re-certify more than once a year?
Answer/Shulin Lin: Yes, January 1st. At a minimum of six months under the new HR1 regulation.
Question/Supervisor Candace Andersen: Do we have any indication as to why the SIS population
is declining? Is it failure to enroll?
Answer/Shulin Lin: Leaders in the organization are analyzing that decrease
CCHP Information Technology Report
5.0
Overall, membership has remained flat. There is a decline in documented enrollees and an increase
in undocumented enrollees. Between 500-900 documented members are moving to Kaiser every
month.
The number of appeals and expedited appeals over the last year has stayed relatively flat. The
primary reason for appeals is the quality of service. The number of grievances has stayed flat with
data showing 1.7 grievances per 100K members, which is below the state average. The primary
reason for grievances is quality of service.
For the past year, the new Advanced Claims Dashboard has been active. This tool helps Claims and
Provider Relations with contract negotiations, offering real time statistical analysis of data.
Under Dr. Lo’s leadership, there has been further collaboration between IT, Provider Relations and
Contracts, and Claims. This has led to better oversight in the contracting and payment process for
claims.
Question/Supervisor Diane Burgis: In relation to the interest, was it not entered correctly?
Answer/Bhumil Shah: Contracts are very complex and individualized and need to be programmed.
Due to the lack of coordination, we were paying over the base rate which led to provider
underpayments. However, the 45 day window had passed which resulted in accrued interest. We
are exploring ways to standardize some of our contracts to reduce the variables encountered
within the provider negotiation process and to establish better coordination between IT and the
contracting team.
Question/Dr. Gabriella Sullivan: With the decrease in the number of SIS members, how is it that
patients can choose Kaiser with their Medi-Cal?
Answer/Dr. Irene Lo: Kaiser has a state-wide contract for Medi-Cal which includes specific
criteria used to determine if a member goes to Kaiser or to CCHP. I can provide specific contract
guidelines offline. Due to the criteria, many members have been able to move to Kaiser.
Question/Supervisor Diane Burgis: Is part of it the lack of options such as being unable to get a
primary care physician?
Answer/Dr. Irene Lo: Yes, absolutely - network adequacy and access
Legislative Update
6.1
The federal government shut down as of October 1, 2025, due to the inability to pass a continuing
resolution (CR) to keep the federal government funded. We anticipate that it could last at least a
couple of weeks, potentially longer. The CR would include cuts to Medicaid DSH funding and an
extension of Medicare telehealth flexibilities.
Congress has delayed Medicaid DSH cuts for the last 11 years, and we assume that when they pass
a CR, they will pass a delay that will be retroactive. Annually it is a cut of $20 million for Contra
Costa, with payment given quarterly of $5 million. If the federal government does not reopen by
mid-October, the cut will go through. While Contra Costa will get some DSH funding, it will not
get the full allotment. If Congress passes a CR with a retroactive delay, the money will likely come
back in December or January.
A rural health transformation program will allocate $50 billion, split among the states, to be
distributed at the agency’s discretion. Allocation to every state, by the Health and Human Services
Agency, is not required. There is no guarantee that funding will be received. Efforts are underway
in California to submit an application that meets requirements.
