Program for Needy Is Delayed

Federal regulators have again refused to allow full implementation of L.A. Care, the nation’s largest local managed care program serving the poor, saying they still aren’t convinced the Los Angeles County program is ready to go.

Regulators with the U.S. Health Care Financing Administration notified the state late last week that they want to see more progress in an enrollment and community outreach plan before allowing L.A. Care to proceed full throttle.

L.A. Care is a locally organized program, consisting of seven HMOs, that when fully operational is expected to enroll more than 600,000 Medi-Cal beneficiaries.

The federal delay means that while Medi-Cal beneficiaries can continue to voluntarily join the seven L.A. Care plans, they cannot be automatically assigned to a plan until Oct. 1 at the earliest. The automatic assignments were to be made by the state starting Sept. 1 whenever patients failed to choose a plan.

The lag of at least one month is bad news for L.A. Care, which had counted on keeping enrollments up--and money flowing into the program--partly through automatic assignments, or “defaults.”

This latest delay is the second ordered this year by federal regulators. In March, regulators ordered immediate suspension of automatic enrollments because the process was too confusing for Medi-Cal beneficiaries.

Since then, L.A. Care has submitted a detailed plan to resolve federal concerns.

L.A. Care’s chief executive officer, Anthony Rodgers, said Monday that his organization has about 40,000 fewer Medi-Cal beneficiaries than it had anticipated. The lower enrollment means that the organization’s budget of $1 million per month is half what was projected.

“I don’t want to cry wolf,” he said. “We will know in 30 to 60 days whether this will create a significant problem for us.”