State Programs on Health Care
Your editorial (“Adrift in a Sea of Jargon,” Jan. 28) accuses the state of attempting to move Medi-Cal beneficiaries into managed health-care plans by “turning loose the sales forces of the competing private organizations to chase down Medi-Cal recipients and persuade them to choose managed care of their own volition.” Nothing could be further from the truth. Neither door-to-door marketing nor the wholesale “transferring of Californians from Medi-Cal to private managed care” is an element of the administration’s Medi-Cal Managed Care Initiative enacted by the Legislature last year.
Door-to-door marketing has been legally authorized for Medi-Cal managed-care plans for 20 years. Serious and relatively widespread abuses in the early 1970s led to legislation and substantial program changes, resulting in real improvements. Since then, we have periodically found some marketing problems caused by a few unscrupulous individuals. But this kind of abuse is entirely unacceptable and Medi-Cal has and will continue to vigorously remove those responsible from participating in the program.
Even with the intervention of the state Department of Justice, however, this is not always easy. Because of this, we are seeking additional statutory authority in order to enhance our ability to deal swiftly with those who violate standards.
More important, too much attention has been focused on these negative incidents--repugnant as they are--and not enough attention has been paid to the positive aspects of managed-care programs. Contrary to The Times’ assertion, managed care is not “cut-rate” health care, and reducing health-care costs is far from the only benefit of managed-care programs. The most important benefits are increased access to and continuity of care.
The Medi-Cal program has been authorized to directly enroll Medi-Cal beneficiaries to managed-care plans if they do not already have an established relationship with a primary care provider, beginning in January, 1994. Medi-Cal beneficiaries without a primary-care provider will be given information about managed care and the choice of available plans by a private contractor who is independent of the participating health plans.
In the meantime, I have ordered my staff to institute a grace period for Primary-Care Case Management and Prepaid Health Plan contractors. Enrollments obtained as a result of door-to-door marketing would not be submitted for processing for three days. The beneficiaries will be told that during the three-day period they may stop further processing of the enrollment simply by contacting the plan, and do not need to give any reason.
MOLLY JOEL COYE MD, Director, Department of Health Services, Sacramento
