Prince George's County work group weighs Montgomery Cares model as Health Assurance funding remains tight

Prince George's County Council health work group members on a county virtual meeting reviewed Montgomery County's Montgomery Cares program this month as they seek ways to stabilize and expand the county's Health Assurance program.

Diane Young, of the Prince George's County Health Department, presented findings after meeting Montgomery Cares staff and said the Montgomery program had "a total budget of nearly $16,000,000" for FY25 and served about "22,000 residents annually" with "over 60,000 visits a year." Young said Montgomery Cares is managed by the Primary Care Coalition with county oversight and includes an eligibility system, annual recertification and outcome reporting that Prince George's' current reimbursement model lacks.

The Health Assurance program in Prince George's County currently reimburses at $180 per visit, Young said, compared with Montgomery Cares' reimbursement of about $102.50 per visit. Young also flagged differences in administrative scale: Montgomery Cares' administering organization has roughly two dozen staff supporting pharmacy access, specialty referral coordination and data reporting, while Prince George's County currently has a much smaller staffing footprint for the program.

Why it matters: Work group members said the county faces both immediate funding shortfalls and a longer-term need to build program infrastructure so that a Health Assurance expansion would be accountable and sustainable. Council members and subject-matter experts warned that one-time or grant funding is likely to be insufficient to sustain the kind of centralized program oversight Montgomery Cares provides.

Participants repeatedly noted three central trade-offs: (1) short-term stabilization to prevent FQHCs from leaving the county and to keep current services running, (2) investment in administrative infrastructure and quality metrics to manage a scaled program, and (3) the need for a durable local funding stream rather than reliance on discretionary federal funds. Several speakers also discussed patient-facing design elements used by Montgomery Cares, such as a modest uniform copay (reported as $25 historically and possibly $35) that can be waived for those who cannot pay, and a pharmacy access component Montgomery Cares supports with roughly $6,000,000 worth of pharmaceutical access.

"Health Assurance has been limping along, for almost 9 years now," Young said, arguing that Prince George's County currently operates a reimbursement model without the eligibility, data and quality-assurance systems Montgomery County uses.

Dr. Matt Levy, the county health officer, told the group the department supports finding a workable solution but cautioned that administration of even a modest expanded program requires staffing and oversight resources. "A million dollars is not gonna make a big difference in the broader scheme," Levy said, noting that program administration consumes a share of any initial allocation.

Sharon Zalewski, executive director of the Regional Primary Care Coalition, clarified program mechanics from Montgomery Cares: copayments go to providers (not a central fund), copays are uniform across participating sites and must be waived if patients cannot pay, and the Montgomery model includes recruitment and credentialing of provider groups rather than individual providers.

Work group members discussed immediate next steps and deliverables. County staff agreed to circulate Diane Young's notes and Montgomery County meeting materials to the group. The committee director said the group will develop both short-term recommendations (to stabilize current services and funding) and long-term recommendations (to build a program infrastructure and identify sustainable funding streams). Members also said they will continue budget advocacy during upcoming county budget negotiations.

Votes at a glance: The committee approved the minutes from the prior meeting by voice/no-objection. A participant moved to approve the minutes as written; the motion was seconded and the chair recorded no objections, so the minutes were adopted.

What remained unresolved: Members did not adopt a single implementation model. Instead they asked staff and committee members to draft options that include (a) short-term measures to shore up funding and (b) long-term steps to create administrative capacity, quality metrics and a durable funding source. The group also requested reports or routine materials from Montgomery County showing program reporting and oversight practices for consideration.

Next steps: Staff will circulate meeting notes and Montgomery County materials; the work group will meet monthly after budget negotiations to finalize two tiers of recommendations (short-term and long-term) and prepare to present those recommendations to the County Council and incoming county executive.