CALIFORNIA: HCFA ORDERS SUSPENSION OF LA HMO ENROLLMENT
The Health Care Financing Administration (HCFA) has orderedThis is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
"the state to immediately suspend plans for automatic enrollment
of poor people in managed care in Los Angeles County." HCFA said
that the state must delay automatic enrollment "because
instructions to patients on their health care provider choices
are confusing, and HCFA has doubts about the ability of the
contractor to handle enrollment and educate patients." In
addition, LOS ANGELES TIMES notes that one of the county's two
managed care plans, which is scheduled to start April 1, "does
not yet have a license to operate." Under the state's plan,
Medi-Cal beneficiaries would have a choice between LA Care -- "a
partnership of six private and one public plan" -- and an HMO,
Foundation Health.
A MATTER OF OPINION: Elizabeth Abbott, HCFA's regional
administrator in San Francisco, wrote in a letter to the state,
"We are gravely concerned about the impact these implementation
problems will have on beneficiaries." She added that "the
suspension will last until the state 'can satisfactorily
demonstrate ... that the system has stabilized in the county and
beneficiaries are being provided with complete, timely and
accurate information about their managed care choices." Medi-Cal
administrator Joseph Kelly "said he is confident the state will
be able to promptly allay federal concerns." He said that LA
Care will be licensed by the state April 1, "and information
given to patients will be made more straightforward."
TROUBLE AHEAD: TIMES reports that the decision means that
potentially hundreds of thousands of Medi-Cal beneficiaries who
do not choose a managed care plan will remain in the traditional
Medi-Cal program. The suspension is also "a setback for the
California Department of Health Services which has aggressively
pushed the managed care model in Los Angeles and 11 other
counties." In addition, the delay "presents a possible problem
for the county of Los Angeles, whose Community Health Plan is a
partner in LA Care." TIMES notes that Community Health "had been
counting on the automatic enrollments for financial stability."
LA Care CEO Anthony Rogers said that if the delay lasts more than
several months, "the seven partners in LA Care could lose
'millions of dollars" (Marquis, 3/28).