Health Commission approves simplification of SF City Option employer-contribution program

The San Francisco Health Commission on June 15 approved a resolution directing the Department of Public Health to simplify the SF City Option (SFCO) employer-contribution program, consolidating three benefit tracks into a single medical reimbursement account (SFMRA) and streamlining enrollment.

Alice Cerniadi of the Office of Managed Care presented the plan to replace the existing three-benefit enrollment (SFMRA, Healthy San Francisco with discount, and SF Covered MRA) with one SFMRA account and a simplified identity-verification enrollment step that will not require in-person income verification. She said the change is designed to remove barriers that have kept many employees from using employer contributions: "The multi-step enrollment process is required to ensure that employees are truly eligible... but it has become a major barrier to participation and utilization of the employer's benefit in general."

The department provided participation figures to justify the change: as of March 2021 roughly 41,000 employees were enrolled in SFMRA (about 98% of participants), ~711 were in HSF with a discount and ~117 were in SF Covered MRA. DPH said only about 20% of employees who received employer contributions had converted those funds into an account under the current system. Under the simplification, the department will auto-enroll existing HSF-discount and SF Covered MRA participants into SFMRA and will deposit a transition subsidy into SFMRA accounts for calendar year 2022 equal to the participants' 2021 covered MRA benefit.

DPH said the changes will have "no impact" on the 98% already in SFMRA and will increase flexibility for employees to spend employer contributions as a dollar-for-dollar benefit. The department also plans to relaunch an affordability program in mid-2023 to continue supporting employees who face cost barriers to enrolling in insurance.

The commission moved and approved the resolution on a roll-call vote. Secretary Moritz recorded affirmative votes from all commissioners present, and the motion carried.

Next steps: DPH plans outreach and stakeholder messaging immediately if the commission's approval is confirmed, implement the transition through the remainder of calendar year 2021 and present details of the new affordability program to the commission before relaunch.