County approves new Medica contract for Special Needs Basic Care; reimbursement rate cut to $135

The Clay County Board of Commissioners approved a new participation agreement with Medica on July 14 that will shift special‑needs basic care (SMBC) case management to Medica effective Oct. 1, 2026.

Public Health Director Jessica Mickelson said the county’s day‑to‑day care coordination work will remain similar, but a key operational change is that Clay County will provide services only to "engaged" SMBC members — those who accept care coordination and complete assessments. Under the UCare arrangement the county often carried responsibility for nearly all enrolled members; under Medica the rate for engaged members is $135 per member per month (Medica initially offered $115, later negotiated to $135), down from $185 previously paid for engaged members under UCare.

Mickelson provided enrollment and revenue estimates: Clay County currently has 292 engaged SMBC members and 761 unengaged members; at $135 the engaged cohort would generate about $39,420 per month ($473,040 annually). She said reductions across three combined programs produce a net projected revenue decline of roughly $299,892, but current projections still cover personnel costs — the care coordination team's projected salary and fringe is approximately $439,000 and projected total revenue across programs is about $473,000, a modest surplus.

Commissioners asked about outreach to increase engagement and whether staff levels could absorb additional outreach responsibilities; Mickelson said lower caseloads (from ~210 to ~73 members per coordinator) create capacity for more proactive outreach. Commissioner Kean moved to enter the Medica contract at $135 per engaged member per month effective Oct. 1, 2026; the motion was seconded and carried by voice vote.

The board’s approval preserves local care coordination services during the health‑plan transition while reducing the county’s obligation for unengaged members.