Local News in Brief : State Urged to Exclude Some From Medi-Cal Experiment

Astate commission this week recommended that certain developmentally disabled Medi-Cal patients be excluded from a controversial state experiment to require Medi-Cal recipients in the San Fernando Valley to receive their medical treatment from health maintenance organizations.

The California Medical Assistance Commission, at its Tuesday meeting in Sacramento, released suggested criteria that would exempt 20% to 30% of the 3,000 developmentally disabled people who are receiving Medi-Cal in the Valley, said Jim Foley, head of the Valley experiment. People are considered developmentally disabled if they are mentally retarded, autistic or have neurological handicaps that affect their mental capacity.

Critics of the experiment, called Expanded Choice, have contended that the developmentally disabled have too many complicated health problems to be treated adequately by HMOs.

The exemption criteria would exclude patients with moderate-to-profound mental retardation or behavior problems, multiple medical problems requiring intensive treatment from more than one physician or a substantial handicap caused by cerebral palsy.

The commission is soliciting comments on the proposed exemption criteria developed by a panel of physicians. The commission is expected to vote on the exemptions later this month.