Grand Jury Recommends CalOptima, Emergency Plan Merger

The emergency health care needs of poor, uninsured Orange County residents are not being met by the county’s underfunded Medical Services for Indigents program, according to a grand jury report released Friday.

“If one is ill and indigent in Orange County, there are ways to obtain medical care; but frequently the efforts needed to find the care, complete the forms and qualify turn away all but the most determined,” the report stated.

The grand jury recommended review of the indigents program’s services, and its immediate merger with CalOptima, the county’s managed-care program for poor families and the disabled.

There are about 476,000 uninsured people in Orange County. All are eligible for some benefits, either under emergency care provisions of the county’s indigents program or through CalOptima.

CalOptima received about $520 million in state and federal funds to provide preventive and emergency health care for about 200,000 county residents the current fiscal year, which ends June 30.

Medical Services for Indigents (MSI) can only help uninsured people ages 21 to 64, and can only provide emergency or lifesaving care. It is considered “the program of last resort,” the report says.

The indigents program received about $42 million in county and other funds this year, and served 26,377 people in the fiscal year that ended June 30, 1997, the last year for which figures are available.

The grand jury found that the indigents program needs to provide preventive and maintenance services, such as follow-up care, but can’t without an increase in funds. It also found that the enrollment application can be difficult and processing can be delayed. Reimbursement to medical providers sometimes falls below 50%, which the report called “inadequate.”

The county has been planning to merge the indigent care program with CalOptima for several years. But funding disputes have delayed the merger, according to the report.

“The plans to integrate MSI into the successful CalOptima program of managed care have been stalled because the county requires it be done at no additional expense,” the report says. “It is difficult to see how quality care can be provided to the MSI population without extra money.”

Alyce Mastrianni, director of quality management and planning at the county Health Care Agency, declined to comment on the grand jury’s report. The agency, which oversee the indigents program, will file a response by Sept. 2, she said.

The grand jury’s recommendation for immediate integration oversimplifies the differences between the two programs, said Jon Gilwee, spokesman for the Healthcare Assn. of Southern California, a hospital trade group.

The report does a good job at presenting an overview, he said, but it oversimplified the financial and structural differences between the two programs, and those differences make a quick merger difficult.

Combining the programs without increasing funding is meaningless, said Kathy Crowley, spokeswoman for CalOptima.

“We could do it immediately, but there wouldn’t be any changes,” Crowley said. “Look at the recommendations in the grand jury report: follow-up care, long-term care, maintenance care. All of these are very costly items.”

Such preventive care may save money in the long term, but there are too many unknowns right now, she said.