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County approves Medica contract for special‑needs care coordination, reducing caseloads but lowering revenue
Summary
Clay County Public Health will enter into a Medica SMBC participation agreement effective Oct. 1, 2026. The change reduces reimbursements from prior rates and shifts care only to "engaged" members; staff said it lowers caseloads per coordinator from about 210 to 73 while reducing annual revenue roughly $403,500 across programs.
The Clay County Board of Commissioners voted July 14 to authorize county public health to enter into a Special Needs Basic Care (SMBC) case management participation agreement with Medica effective Oct. 1, 2026.
Presenter (public health staff) explained that Medica is acquiring certain UCare contracts and that under the new agreement the county will provide care coordination only for members who agree to be "engaged" in services. Under the previous UCare arrangement Clay County provided care coordination to nearly all members — both engaged and unengaged — and received $185 per engaged member and $25 per unengaged member per month.
Under Medica, reimbursement is $135 per engaged member per month. County staff reported current counts of 292 engaged SMBC members and 761 unengaged members. At the negotiated $135 rate, engaged membership is projected to generate approximately $39,420 per month (about $473,040 annually), representing a reduction in annual revenue of roughly $403,500 compared with prior combined rates. Staff said caseloads per care coordinator would fall from about 210 to roughly 73, a change staff described as creating a more manageable care coordination model and allowing greater outreach to enroll members.
Commissioners asked whether outreach could increase enrollment; the presenter said that staff plan targeted touches at enrollment and annually, and with lower caseloads staff could prioritize outreach. Commissioner Kravanoff and others asked whether revenue still covers personnel costs; staff said projected annual revenue ($473,040) would exceed personnel costs ($439,000) by about $33,987 under current projections.
The board approved the contract by voice vote. Commissioners directed staff to continue outreach efforts to convert unengaged members to engaged status and to monitor financial impacts.
Speakers quoted (roles as reported in the meeting): Presenter (SMBC program lead); Commissioner Ebinger.
Ending: Staff will execute the Medica SMBC participation agreement effective Oct. 1, 2026, and return with operational updates as enrollment and revenue data are confirmed.
