Rx Sought for O.C.’s Poor, Uninsured

Orange County’s Medi-Cal agency took the first step Tuesday toward revamping the county’s troubled health-care program for medically uninsured people by approving a plan of action unlike any other in California.

The board of directors of Cal-OPTIMA, which has brought 240,000 Medi-Cal recipients into managed care networks over the last 14 months, agreed to try bringing 30,000 indigent people--many of them seriously or chronically ill--under its enormous umbrella.

The move may be the agency’s most ambitious task yet, as Cal-OPTIMA has tentatively planned to take over the Medical Services for the Indigent program by July, and no one yet knows where much of the money to improve the program will come from. When fully implemented in five years, the program could cost $78 million annually--more than twice as much as the county pays for it now.

The price tag and short timetable worried some patient advocates and health-care providers who were otherwise supportive of the plan.

“We believe a July implementation rate is an unreasonable expectation,” warned Martha Killefer, chairwoman of the Member Advisory Committee that gives Cal-OPTIMA input on patients’ needs.

There is concern among providers “about the potential harm to the [existing] Cal-OPTIMA program,” said Maria Casteneda-Martell, a staff member for the Provider Advisory Committee. Cal-OPTIMA board and staff members said it is time to overhaul a program that has left hospitals and doctors without reasonable compensation, and many patients without treatment until their plight is dire. With no public hospital for support, the county’s medical “safety net” is severely frayed, and a small group of providers bears most of the burden.

“I guess I would ask you when is the appropriate time to do this?” County Supervisor and Cal-OPTIMA board member William G. Steiner asked critics. “The time is about as ripe as it’s going to get.”

The board approved the plan unanimously, even as members acknowledged many unknowns. The biggest mystery is the effect of federal welfare reform on the Medi-Cal eligibility of immigrants. Turning these people away from Medi-Cal could add considerably to the Medical Services for the Indigent rolls.

The next step is for Cal-OPTIMA to negotiate a contract for the program, set to be submitted to the County Board of Supervisors as early as this spring.

The plan approved Tuesday proposes the following changes to improve indigent services program:

* Establishing a means of verifying patients’ eligibility for the program so that taxpayers do not get stuck with unwarranted bills. Critics worry that the verification process might reduce patient access to treatment.

* Establishing a case-management system for patients with chronic conditions to keep them out of emergency rooms, where care costs most.

* Setting up a referral network for specialty and follow-up care.

* Trimming administrative costs.

* Bringing paltry payments to providers up to Medi-Cal levels. This is the most costly element of the plan, but a key to expanding provider networks and patient access.