Effort to Derail Cal-OPTIMA Loses in Court

A judge Tuesday denied a petition from a large national health corporation to halt enrollment in Cal-OPTIMA, Orange County’s new managed-care system for Medi-Cal recipients.

The petitioner, Maxicare Health Plans Inc., argued that enrollment should be stopped because the county lacks federal approval for the program and improperly spent public funds to set it up.

A waiver from the federal Health Care Financing Administration is needed to operate Cal-OPTIMA because the system will restrict Medi-Cal recipients’ choice of medical providers.

But Orange County Superior Court Judge Gary P. Ryan ruled that the county has “every bit of authority” to take preliminary steps to establish the new program while its application for federal approval is pending. The application was filed in April.

Ryan said the county has to be given latitude to demonstrate to state and federal authorities that it has the capacity to operate the program. Cal-OPTIMA officials acknowledge that they are not certain of federal approval, but note that several other counties have gone forward in organizing similar plans while their applications for waivers were pending.

Maxicare was dropped from consideration as a provider in Cal-OPTIMA because officials said the corporation’s application was not filed in time. In court documents, Maxicare argues that it was “arbitrarily excluded.”