Officials Feel the Heat From Foes of New Medi-Cal Plan

The meeting room at a Van Nuys church was crowded and stuffy and tempers were hot when the father of a severely retarded daughter squared off with two state health officials standing uncomfortably in a corner.

“You’ve walked into a buzz saw,” Carlton Chamberlain shouted. “I think the state has felt this kind of thing from the people of the Valley before. I think you’ll feel it again.”

Others, mostly parents of severely disabled children, joined the verbal assault, their voices sometimes jumbled together as they tried to express their fears and vent their anger at the pair from Sacramento.

The meeting, held last week, signaled Round 1 in a fight between the state and groups representing the disabled, elderly and the poor. The battle shows all the signs of becoming more heated as the year progresses.

Expanded Choice

The subject of the groups’ ire is the state’s proposed Medi-Cal pilot project, called Expanded Choice, to begin early next year in the San Fernando Valley area and San Diego. The gathering at the First Presbyterian Church of Van Nuys marked the first time state officials and a group of Medi-Cal recipients or their families had met face to face to talk about the project.

Expanded Choice will require most Medi-Cal recipients to receive their care from a handful of health maintenance organizations selected by the state. Many of these poor, elderly and disabled recipients will no longer be able to visit their own physicians or have prescriptions filled at neighborhood pharmacies.

The aim of the state’s experiment is to trim Medi-Cal costs in these two areas by 5% each year. Gov. George Deukmejian, who wants the program adopted statewide eventually, has endorsed the plan as a way to save taxpayers’ money.

The California Medical Assistance Commission, which is overseeing the experiment, said Expanded Choice also will benefit recipients by providing them with more care options, since many physicians have shut the door on Medi-Cal patients.

Under the plan, 87,000 residents in the San Fernando and Santa Clarita valleys and 165,000 in San Diego County will participate in the Expanded Choice program. Beginning Jan. 1, beneficiaries will have three months to enroll in one of the participating HMOs, which have yet to be selected, before the program starts April 1.

Criticism of Project

Since details of the plan were made public in June, local and state advocacy groups, along with the Los Angeles County Medical Assn. and the California Pharmacists Assn., have criticized the project. Any economic benefit enjoyed by the state, critics contend, will be offset by the disruption of patient-physician relationships and the potential for inadequate medical treatment, especially for the severely disabled and those with rare diseases who require specialized care.

Opponents also worry that there will be a strong economic incentive for HMOs to wash their hands of elderly enrollees troubled with many expensive medical problems by placing them in nursing homes.

A network of diverse community groups, ranging from the Gray Panthers to the San Fernando Valley Assn. for the Retarded to the Therapeutic Living Centers for the Blind, are forming strategies to modify or stop the experiment. Tactics being considered include waging letter-writing and telephone campaigns, lobbying legislators and filing a lawsuit.

“People do not come out of the woodwork until it’s life-threatening. This could be one of those times,” said Karen Gilman, the legislation and advocacy coordinator for the United Cerebral Palsy/Spastic Children’s Foundation in Van Nuys.

State officials said they anticipated the opposition, but not its swiftness. “I think it’s unfortunate it’s happened so soon before we could meet with the groups to tell them what we can accomplish,” said Jim Foley, who is in charge of the Valley project.

He said most of the criticism has come from the Valley, but he doesn’t know why.

The debate has widened to involve Valley legislators, many of whom say they are opposed to the project. Sen. Alan Robbins (D-Van Nuys) said he will introduce an urgency bill when the state Legislature reconvenes Aug. 19 to block the Valley’s inclusion in the project. With the session ending Sept. 13, Robbins will have only one month to try to usher the bill through the Legislature and onto the governor’s desk.

“What they are proposing is a lower level of medical care for the aged, the poor and the disabled of the San Fernando Valley,” Robbins said.

Most of the Valley delegation has endorsed Robbins’ bill, which would not interfere with the San Diego experiment. Supporters include Assemblymen Richard Katz (D-Sepulveda) and Tom Bane (D-Tarzana), and state Sen. Herschel Rosenthal (D-Los Angeles).

Assemblyman Gray Davis (D-Los Angeles) said he strongly supports the concept, but wants to see the bill before he officially endorses it. Rosenthal and Davis represent parts of the Valley.

Assemblywoman Marian W. La Follette (R-Northridge) said she has no comment on the plan now.

Support from Ed Davis

The lone advocate of the plan seems to be state Sen. Ed Davis (R-Valencia). His administrative assistant said the senator, who was unavailable for comment, supports the plan as it was described to him because he thinks it will slow spiraling health care costs while ensuring quality care for the beneficiaries.

Among the legislators’ chief concerns is the state’s intention to use the Valley as a “guinea pig” for a program that still has many questions left to be answered. They see Robbins’ bill as a way to postpone the program until the Legislature can take a comprehensive look at whether the concept can work in California.

“It’s not a very well-thought-out program,” said Katz, who added, “They haven’t made a good case for why they are doing it.”

However, Michael W. Murray, the Medical Assistance Commission’s executive director, said the Legislature mandated the experiments. In 1982, when the state was facing a fiscal crisis, the lawmakers passed a large Medi-Cal reform package aimed at cutting costs. Authorization for the Expanded Choice experiments that was included in the legislation was largely overlooked at the time.

The pilot projects will have safeguards to ensure that quality of care will not be jeopardized, state officials said. Also, a loophole will allow people with special medical needs to stay with their old physicians. Just who will fit that category, however, has yet to be determined.

Groups Caught by Surprise

The experiment, for the most part, caught affected groups by surprise, so protest strategies are in the embryonic stage. Some groups still are searching for answers before they take a position.

Twenty community groups in the Valley and San Diego, including San Fernando Valley Legal Services, submitted a list of 40 questions they want answered by the state before they take a stand. Jim Carroll, a Valley legal aid attorney, said there is “general apprehension” among the groups as they wait for answers.

Expected to take the lead in fighting Expanded Choice are the family, friends and advocates of the developmentally disabled. Unlike families on welfare, who are also included in Expanded Choice, individuals in the developmentally disabled network are politically savvy, having fought battles in Sacramento and Washington for years. For instance, they can reach hundreds of supporters within days through telephone and mail networks.

The last time the group flexed its muscles on a large scale was last year, when the governor threatened to blue-pencil a $1.9-million appropriation for the developmentally disabled. Through lobbying and a demonstration strategically held when Deukmejian and representatives of the press were at the governor’s Los Angeles office, the $1.9 million was saved.

Complicated Ailments

Because the developmentally disabled often also have complicated medical problems such as epilepsy, respiratory and intestinal ailments and behavioral disorders, it sometimes has taken years for parents to find the right doctors for their children. Also, it often takes time for the physicians to find the right balance of medications to treat these patients.

To take these patients away from their doctors would be a crime, said Ben Waxman, an attorney and a director of the Valley Assn. for the Retarded, echoing the sentiments of other parents who attended the Van Nuys church meeting.

“You’re going to see a concerted effort from a lot of different groups,” Waxman promised. “Believe me, we send telegrams galore.”