County’s New Health-Care Program for Poor Delayed : Medi-Cal: Postponement of the OPTIMA plan is the result of the bankruptcy and delays in getting reimbursement information from the state.

Burdened by the county bankruptcy and beset by delays in rate-setting by the state, leaders of the county’s new managed health-care system for the poor Tuesday postponed the unprecedented program’s start-up date by at least a month.

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The delay, approved unanimously by the board of the new OPTIMA program, means the Medi-Cal system, designed to bring some 300,000 patients into managed care networks, won’t be up and running until Sept. 1. Enrollment is scheduled to begin Aug. 1.

But the board left open the possibility of delaying enrollment yet another month when it meets May 9.

The postponement was needed in part because the state commission that determines Medi-Cal reimbursement rates is about four months behind schedule in releasing its proposed rates, said Mary K. Dewane, OPTIMA’s chief executive officer. Those proposed rates, expected in January, were not received until last Friday, Dewane said.

Dewane said the county needs at least four or five more weeks to negotiate with the state and provide the final rates to the 48 health-care organizations that have bid for OPTIMA contracts.

The potential Medi-Cal contractors have complained for months it is impossible for them to finalize plans to participate in OPTIMA without knowing how much reimbursement they could expect.

Under the OPTIMA system--the only one of its kind in California--Medi-Cal providers will be paid fixed fees per patient instead of receiving fees for each service rendered. The idea behind the system is to increase patients’ access to care while keeping costs down.

But OPTIMA was set back, as well, by the county’s declaration of bankruptcy Dec. 6. About $2.4 million in start-up costs for OPTIMA was caught up in the bankruptcy, causing the organization to impose a two-month hiring freeze just as it was getting off the ground.

“We were like a rocket taking off,” said OPTIMA spokesman Mike Stockstill. “Just as we were leaving the launch pad, the bankruptcy hit.”

OPTIMA officials say they hope to recoup $450,000 of the organization’s money from the county under a bankruptcy settlement plan that is scheduled to be considered by U.S. Bankruptcy Judge John E. Ryan May 2. Dewane said if that money is recovered and can be put toward start-up costs, it would be best for OPTIMA to delay its start up yet another month, beginning enrollment in September rather than August.

Each month of delay costs OPTIMA money, because the system must use a portion of some $6 million in start-up funds it has raised and borrowed, mostly from private medical sources.

But OPTIMA officials said Tuesday that they will delay some hiring and other expenditures to compensate.