second meeting. as well as go over the impact that was requested by the commission and so to review, and at the september second meeting, we recommended the following changes, on the healthy san francisco side and we recommended that the current transition period, which allows the people who are eligible for coverage california to enroll in and or stay, in healthy san francisco, and be extended to another year, through december 31, 2015, and we also recommended that healthy san francisco are expanded to allow uninsured seniors to participate, and we recommended lowering the upper almost level

from 400 to 500 percent of poverty to align them with the subsidies under the affordable care act and all of these policies were designed to or in tended to maintain the continuity of coverage and to reduce the gaps as well as to make sure that hel ygt san francisco is available able for the people who don't have other options and the city option, on the side, and we sought, to encourage the use of the mri funds that are contributed by the employers, and from the hcso.

totals include the cost of providing care for senior and providing care for under, healthy san francisco and then savings would be, and it would be realized from the people leaving the program as well as the cost ainvoice ans for caring for people through a cost effective manner through hel ygt san francisco and i will go through the details on each policy. >> and so, for the extending the healthy san francisco, transition, period it is actually the most costly of all of the changes that we have proposed. and currently for the 2014, calendar year, and we estimate that it costs 8.2 million

dollars and this amount is corrected for an ongoing, decline that we are seeing, and in the healthy san francisco enrollment. and so, we have corrected that for the people who are taking advantage, of the extension period, currently, and so... >> just a point of clarification on that. >> sure. >> if we did nothing, today, and we did not accept your recommendation. like, that cost in 2014, would, and we would still incur that, correct? >> and if we. >> we have the people that are currently enrolled in hel ygt san francisco and through the end of this calendar year and that is already happening. >> right. >> and so that 8.82 million will be incurred for 2014. >> if we did nothing today. >> if we did nothing today. >> how is that an additional cost to your recommendation. >> the 2.67 million for next year is an additional cost. >> 8.28 for this year. >> right >> is not like, and that is happening. >> that is already in effect. yes. >> or, are we talking about the calendars years or fiscal years.

i should clarify that these are calendar years and anything that is a 2014 cost is the current year cost under the existing policies. >> so, for 2015, again, if we, assume that that enrollment continues, we could expect to see, to encure the cost of 2.67 million, and then in 2016, and once that transition period ends, and we would realize that the savings, and because the people who are taking advantage of the transition, would no longer be eligible. and but, for it to the commissioner singer's point, and we do have another open enrollment coming up, and we may realize what we may not incur all of these costs because we may have an exit from the program. >> my point was different. and my point was that, as, as we look at the incremental cost of what you are asking us to approve, and it is really, what is in 15 and 16. >> and to everything else. and we have, we are doing. >> yeah. >> and yeah, that is right.

>> and so, do you mean, incremental costs? because, this says that our current program, with the lesser enrollees but adding the seniors is 2.67, million? >> and this is to determine in the incremental cost? >> and where to find the 2.67, because we have some people, already, on the program, where we are adding the seniors. and one of the questions was how much is it costing us, to add the seniors? >> but, that i will go over that in the next. and this particular, slide is just for extending the transition period. and so, just, the healthy san francisco. and allowing the coverage california and this will cost us to extend the transition period. >> yes. >> for one year. >> and to ex-expand the eligibility for seniors, currently our 2014 cost, for caring for our seniors who are uninsured is 2.56 million dollars, and we are getting

that, by using charity care, report and so, in 2015, if all of the seniors were to transfer to healthy san francisco, because the healthy san francisco, per person cost is actually lower than our charity cost, properson cost and we will actually be paying, less for them, at 2.39 million dollars. >> and then, in 2016, so, it is something is in the 2015 cost is that also, will include, and if we were to allow the seniors in, and we will have to allow them to take advantage of the transition period and so we have built in, a higher estimate in 2015, saying that more people will be enrolled, and then in 2016, fewer people will actually be eligible for healthy san francisco, and this costs should go down. >> is this, and is that 14 costs. and generally, fund, costs or is it your estimation of what we pay, as a system, giving charity care at other hospitals? >> that is the general fund cost, to dph.

>> and from charity care,and we

expecting them go into healthy san francisco that we are going to have lower costs for them, and because, they will get into

other parts of the system, which will then cover the cost. and so, is that what you are saying? >> i aapproximately pologize for that confusion, the charity care costs that i am referring to are the charity care costs for the department of public health and so that will be general and for, you know, you are right, we don't see all of the uninsured. >> okay. >> in our department. >> and so then this will have more of the uninsured, seniors being seen under healthy san francisco. and get into the other part of the system. >> yes, sir. >> coleen do you worry about leakage from everyone that does the charity care in the city? to us? and healthy san francisco? >> so. the hospitals are provided the charity care in the city through their, and i mean that through the healthy san francisco programs and all hospitals participation in the healthy san francisco is as the charity care and thes not paid for by the city.

>> and it is, a program that harasses the charity care object gli gaysings that the hospitals already have and so we would not expect an increase in the cost of hospital charity care, if they moved into the healthy san francisco. >> right. but my question is a different one and it is, do you, and so, i am, and for example, i am documenting 17-year-old, and i am low income, and san francisco, the principals, and you get the healthcare. and today, that person could be in an institution outside of the dph, and being treated under charity care and they could move in, under this, in to healthy san francisco and it might be the right quality thing and i am asking a question. >> that is correct. >> and we could move into, healthy san francisco, and keep their same hospital providers. >> and so, i understand that. yeah. >> but, you, and i think that we just have to, keep the nose out, and this is not that many people that remember, any way but just keep the nose out that

the concerns that the staff has raised previously about you can among them, that about this issue, so, i just think that we, everyone has got to participate in that. >> right. and the request that we had the last time was to give it to the financial review of what the proposal was and so this is an attempt to do that. >> and so, that the net and, like, what you are asking us to, and what you asked us to vote on last time, and now. is a net, extra spend, of, 6.85, plus, 0.69. roughly. >> and so,; is that correct?? >> okay. >> i move that we accept and go back and vote on the... on the resolution. >> yeah. >> the resolution. >> and yeah, now that i understand this. >> and i would hope that you would change the word endorses us to approve. and because we are supposed to approve the changes, right? >> could i make one more, and if we are going to use the resolution, and we should actually be approving these changes, right? >> and thank you.

>> yes. >> and that is all, and thank you for the two of you and with regard, and when you don't understand the facts and you are trying to go with it... and the policy for me is uninsured means, you know, it means no healthcare and so i think that we will proven otherwise, i think that we will need to make sure that these individuals that don't have insurance have access and i think that san francisco comes in and counting 370 bodies and so for 6 million dollars, we are going to insure, 370, which is 80, senior and 175, below the federal poverty level that were not able to get in and the 117, that did not have proof of non-insurancebility, and so about 370, and so is that the way that and is that the correct way to think about it and, is 370 and cost us $6 million and next year because of the savings and the transfers to medical those will all net out and we will get down to zero which is 700 million, which is do the right thing for one year, and, that,

if that so me is what i am understanding, because i am not sure that i am understanding. >> actually i would say that the largest, number of patients, that were, participants that we are talking about are in the transition period and there are nearly 5,000 of those. there are 5,000 people who are in healthy san francisco now who are eligible for coverage california. and so, we will do, what we can in our enrollment process and then we, the renewal of the healthy san francisco to make sure that we council them on the obligation to maximize the enrollment out of healthy san francisco and health insurance. >> and that is better, for the 6 million that do the right thing for 5,000. >> sxh commissioner, also, just to note that presently, our network does not have a coverage california, contract and so, we are negotiating, and negotiations for that, now. and which would be a link, so that the people who are with us, now,

terms of the reduction, and rates, and in closed section, we approved the report and, approved the program and on the commissioners want to add any items. >> and if not, any questions on that, otherwise, we will go on to our next item. >> item 13 is committee setting. >> item 13, is the agenda setting and we have seen that we just reset an agenda for the

san francisco health network, and report, and i am not aware of any other s except for did you want to report on the finance committee? s >> or maybe you did it already? >> i reported on the finance committees already, but we did hope to plan, a set of, and set a one, and schedule meetings in the future to use that as a planning, meeting, and that i believe, that we are looking at the beginning of the year, to do that. and when we have the clearer, and calendar. >> and is there also, and i will ask the director, and in terms of the upcoming budget, is there any sense of direction in finding for that? >> they have not released, i know that this city, now is working on the five-year, plan projections, and from the city, and so, that will inform us, and then, we will used to get it probably in december, and in

december, >> around december. >> yeah, so we are already working internally and we two budget meetings, one before and one after. >> all right, any further it efms for us to consider under the agenda setting. if not, we will go on to the next item please? >> we are on a closed session vote. >> commissioners? >> and we are there and any public comments on the closed session? >> there were not any questions. >> then we are prepared to vote on whether to hold a closed session, motion to have a closed session. >> okay, a second? >> second. >> all in favor. >> please say aye. >> aye. >> all of those opposed. >> we will enter into the closed session and we are going to move into our adjacent room. >> okay, thank you. >> and commissioners, we are now back in open session. and are there any about ready? >> yeah. >> and okay. and thank you. >> we are back in open session,

and a motion is in order, whether to disclose or not to disclose, our closed session, >> i move not to disclose, and the discussion, that we have been in the closed session, and i second. >> and okay. >> and we are ready, and all in favor. >> say aye. >> aye >> all opposed. >> okay, a motion for adjournment is now in order. >> i move that we adjourn. >> second. >> all in favor. >> a aye *. >> this meeting is now adjourned. >>