County Sifting 15 Applicants for Medi-Cal Plan

Fifteen hospitals, insurance companies and health plans have applied to become providers of medical services for Medi-Cal recipients in San Diego County under an experimental plan designed to save the state millions of dollars.

The California Medical Assistance Commission began evaluating the applications Monday, the latest step in a process scheduled to climax April 1 with the enrollment of about 130,000 poor people from the San Diego area in health maintenance organizations (HMO).

The state hopes to shave about $8 million from the projected $162-million price tag for Medi-Cal beneficiaries’ health care in San Diego County during the first year of the project.

Instead of reimbursing doctors, pharmacists and other health providers as services are delivered to Medi-Cal patients, the state will pay HMOs a single monthly fee for each person’s medical care. Officials predict that the change will strip providers of the incentive to provide excessive services and will spur them to cut costs by managing health care more efficiently.

Critics of the “Expanded Choice” pilot program, however, say that the plan will reduce the quality of health care for Medi-Cal recipients, sever longstanding doctor-patient relationships and confuse patients accustomed to obtaining services from the doctor, clinic or hospital of their choice.

Michael Murray, executive director of the commission, said Monday that the receipt of applications from several HMOs open to all San Diego area physicians should diminish the worry that patients might be unable to continue seeing their current doctor once the pilot program begins.

“I’d be very optimistic we’re going to get the (current) Medi-Cal providers and that there will be continuity of care,” he said.

Based on the applications received, Medi-Cal recipients probably will be able to choose between HMOs that provide all services at a central location, such as the Kaiser Foundation Health Plan, and plans that provide services through individual physicians working from their existing offices.

Plans seeking to participate in Expanded Choice are:

Grossmont Health Plan, an arm of Grossmont District Hospital; Cigna Health Plans of California, in conjunction with the San Diego Foundation for Medical Care; the Northeast San Diego Health Plan; Pro Care; Community Health Group Inc., an arm of the San Ysidro Health Center, and Mercy Expanded Care, associated with Mercy Hospital.

Also, Av-Med of California; U.C. San Diego Health Plan; Amicare Advantage Plan; Greater San Diego Health Plan; United States Health Plans Inc.; United Health Plan; Protective Health Providers; Secure Care Health Plan, an arm of the Palomar Pomerado Hospital District, and Kaiser.

According to Murray, several of the plans must obtain state licensing as HMOs before they can be awarded Expanded Care contracts.

During the next two months, meanwhile, the commission will conduct its own evaluations of the applications, Murray said, to assure that critics’ concerns about quality and continuity of care are addressed.

From the applicants, the commission’s staff will select a list of proposed Expanded Choice participants by late October. The commission will hold a public hearing on the proposed HMOs in November and complete contracts by the end of the year.

Medi-Cal beneficiaries then will have 90 days from Jan. 1 to choose a plan. Those who don’t will be assigned to an HMO before the program kicks off April 1.