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Board hears that Laguna Honda and network gaps push some SFHSS members out of county for skilled nursing
Summary
Blue Shield told the board its Medicare process centers patient/family/provider choice and that 11 of 15 San Francisco skilled nursing facilities are in-network; members and clinicians said Laguna Honda often will not accept Medicare Advantage/commercial patients and urged MOUs or letters of agreement to preserve in-county access.
Representatives from Blue Shield of California (Liz Kanape and Charles Lee) presented findings on skilled nursing facility (SNF) availability and selection. Blue Shield said selection is led by the patient, family and medical team; after a SNF is chosen, the facility coordinates with Blue Shield to obtain authorizations. The carrier reported 15 SNFs in San Francisco as a snapshot from November: 11 contracted with Blue Shield and 4 not contracted (Laguna Honda, Hayes Convalescent, Laurel Heights, and San Francisco Towers). Blue Shield noted the GMAPD PPO allows out-of-network Medicare-participating providers if the facility agrees to accept Blue Shield members.
Public commenters and clinicians countered that practical placement is constrained. Dr. Teresa Palmer, a geriatrician and city retiree, said hospitals and insurers often push discharges to facilities the insurer will approve, that patients are not always informed of rights, and that Laguna Honda commonly will not accept Medicare Advantage or commercial insurance. Callers urged the board to seek a letter of agreement or other arrangement between Laguna Honda, the Department of Public Health, and insurers so retirees can remain in-county for short-term rehab.
Blue Shield acknowledged variation in licensed versus usable beds and noted its November snapshot may fluctuate. Board members and advocates asked staff to explore coordinated steps with the Department of Public Health and other city agencies to preserve in-county placement options and ensure oversight of SNF quality and capacity.
There was no board vote on network changes; the board took public comment and asked staff to follow up.
