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Sequoia Healthcare District $1.35 Million subsidy of Children's Health Initiative revisited

Original post made by Jack Hickey, Woodside: Emerald Hills, on Jan 22, 2013

Below is a link to the minutes of the Sequoia Healthcare District at which they first approved the Children's Health Initiative subsidy.

I invite reader comments about the cost effectiveness of this program.

Web Link

The Board had been provided with information outlining the County's request that the District commit $1.35 million annually for five years to help support San Mateo County's Children's Health Initiative. Ms. Taylor stated that the initiative would:
• Insure that all children from age 6 to 18, who reside within the District, would have access to comprehensive health insurance coverage.
• Provide health insurance to approximately 3,900 uninsured children in the District.
• Link 2,450 uninsured children to Medi-Cal and Healthy Families.
• Cover 1,450 children through a new "Healthy Kids" program for children living in households with incomes under 400 percent of the federal poverty level (single parent with 3 children is $67,155).
• Cost $5.4 million countywide.
• Expand existing outreach in order to enroll more families in Medi-Cal, Healthy Families and Healthy Kids program.
• Develop an evaluation component to measure the initiative's effectiveness. Also, compliance with the "terms and conditions" stated below should be questioned.

EXCERPTS from meeting minutes:

"After discussion of the merits of this program, Director Faro stated that the vision to make available access to healthcare to every child within the District fits the philosophy of this Board and he offered a motion to grant $1.35 million for 5 years to help fund the Children's Health Initiative with the following terms and conditions:
1. The District remains a sovereign entity with the ability to collect taxes.
2. San Mateo County will match each dollar provided by the District.
3. The District's grant will be used only to fund health insurance for children living within the District.
4. The District's grant will be funded only from tax receipts collected in the current year.
5. The District's contribution to the program will not exceed more than 25% of the total cost of the program, or $1.35 million, whichever is less.
6. The District will receive at least quarterly updates and progress reports.
7. The District's grant will be funded on a semi-annual basis after receipt of an invoice.
8. If the program is terminated or substantially modified at any time during the five-year period, the District may withdraw any remaining grant funds not yet paid.
9. San Mateo County and the Children's Health Initiative will hold the District, its directors, officers, staff, and representatives, harmless, and indemnify and defend them from any and all claims brought in connection with the District's participation in the program."
Director Kane seconded the motion which passed by roll call vote as follows:
Ayes: Director Faro, Director Kane, Director MacNaughton, Director Shefren
Noes: None
Abstain: None

I have appended a relevant letter to the editor published in 2003. I agree with the second suggestion.

Alternative school funding solutions offered
Here are two alternative solutions to San Mateo County's school funding shortfalls, which will result due to state budget cuts.
1. Place a requirement that children of U.S. citizens, only, be allowed to participate in San Mateo County's Children's Health Initiative. According to some demographers, this would allow up to $2.6 million of the initiative's cost per year to be allocated for the county's school districts.
2. Lower the Children's Health Initiative's income threshold for qualification from $61,000 to $28,000 per family. I believe that perhaps as much as half of the $7.7 million cost could then be directed toward school programs.
Eric von Stoeffel
Menlo Park

Comments (3)

Like this comment
Posted by Jack Hickey
a resident of Woodside: Emerald Hills
on Jan 29, 2013 at 11:30 am

I neglected to mention that this was approved on August 28, 2002. I was reminded of this by an invitation to the 10th anniversary of the CHI. I will be reviewing the files on CHI at the District office today.


Please join in celebrating the:

10th Anniversary of the
San Mateo County Children's Health Initiative

Wednesday, February 6, 2013
10am - 12pm

Sobrato Center for Nonprofits
330 Twin Dolphin Drive
Redwood City, CA 94063

To RSVP and for more details, please see attached invitation

Srija Srinivasan
Director of Strategic Operations
San Mateo County Health System
225 37th Ave.
San Mateo, CA 94403

Like this comment
Posted by Jack Hickey
a resident of Woodside: Emerald Hills
on Feb 12, 2013 at 2:32 pm

A review of the files at the District office revealed nothing to assure that compliance with the terms of the CHI agreement was being documented.

Appended below are communications with CEO Lee Michelson seeking such documentation.

-----Original Message-----
From: Lee Michelson
Sent: Monday, February 04, 2013 10:24 AM
Subject: RE: Children's Health Initiative

I am expecting the latest report soon and I am attending the next advisory meeting in about a week.. as soon as I get the new documents I will share info with you.

-----Original Message-----
From: []
Sent: Monday, February 04, 2013 10:03 AM
To: Lee Michelson
Subject: Children's Health Initiative

Lee, twice a year advisory meetings, with each one reported in your CEO report, plus a progress report with each invoice (provided that these reasonably approximate a quarterly distribution) would satisfy the quarterly report requirement in our agreement. I trust that you will make these available for my review.
I would also like to review documentation demonstrating compliance with these additional terms and conditions:
2. San Mateo County will match each dollar provided by the District.
3. The District's grant will be used only to fund health insurance for children living within the District.
5. The District's contribution to the program will not exceed more than 25% of the total cost of the program, or $1.35 million, whichever is less.

Jack Hickey

-----Original Message-----
From: Lee Michelson
Sent: Monday, February 04, 2013 9:28 AM
Subject: FW:

They have been making reports on occasion at our Board meetings and I attend their twice a year advisory meetings. We will make sure that we receive the progress reports each time and I will not mail current check until I receive the report. Once I receive it, I will email you a copy. Lee

-----Original Message-----
From: SSrinivasan []
Sent: Wednesday, January 30, 2013 2:38 PM
Subject: RE:

Hi Lee,

I apologize if my monday email did not answer your concern. We can definitely get you a progress report and I am sorry if you had conveyed your expectation that we include a progress report with the invoice. I have asked Marmi to prepare the report, which I will review and then get to you.
Given the to do's for our next week event, I think it will be something we can put together soon after,

We will be recognizing you and each core funder at the event next week. We also would be pleased to do a special thanks at an SHCD board mtg of your choosing. I had understood that you would let us know a desire date after the event?

PHCD gave us an award at their mtg last week. We were appreciative of that and thanked them for that honor.

Let me know if we should chat by phone on this, Lee.

Thanks much,

[Message delivered by NotifyLink]

----------Original Message----------

From: "Lee Michelson" <>
Sent: Wed, January 30, 2013 1:37 PM
To: "'Srija Srinivasan'" <>, "'Ron Robinson'"

I am not sure if you answered my concern about sending an invoice without a progress report? Also, when do we get our award? I heard that you gave Peninsula's theirs already.

Lee Michelson, CEO

Sequoia Healthcare District

525 Veterans Boulevard

Redwood City, CA 94063

Office: 650 421-2155 x 202

Cell: 650- 714-5468

Fax: 650 421-2159

Web: <Web Link;

Like this comment
Posted by Jack Hickey
a resident of Woodside: Emerald Hills
on Feb 19, 2013 at 10:45 am

Message from CEO, Lee Michelson, to Directors:
"I attended the Healthy Kids meeting last Friday. Currently there are 4,700 children enrolled. It is believed that about 700 of these children will be eligible for Medi- Cal next year reducing the size of the program to 4,000. Due to lower birth rates and the slow- down of immigration it is expected that this number will continue to be reduced. I have asked for a detailed demographic breakdown as well as a 5 year enrollment projection to help guide our future funding decisions. Lee"
There is little evidence that the terms and conditions of this program are being met. Benefits derived by District residents do not justify continuation of the $1.35 Million annual grant from the Sequoia Healthcare District.

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