CALOPTIMA: Asking State for Budget Hike
"Caught in the cross-hairs of dollar-driven HMOs and balanced- budget-bound federal bureaucrats, both doctors and hospitals" are seeking help from CalOPTIMA, Orange County's Medi-Cal managed care administrator. CalOPTIMA, in turn, is looking to the state for a boost in its $510 million budget. Fountain Valley Regional Hospital President Tim Smith said, "All of these payers are steps. If we're not able to get more money to cover more costs from CalOPTIMA, we might not have any luck with Medicare or with the HMOs. It's all important, and so we try to make our case with all of them." The Orange County Register reports that an average patient costs hospitals about $1,600 per day, but CalOPTIMA only reimburses about $930. "That means the other rate payers have to make up that cost or the hospital has to find a way to make it work," said Jon Gilwee, vice president of the Healthcare Association of Southern California. He said if they can't make it work, and the state cannot boost CalOPTIMA funding, they may have to drop out of the program. CalOPTIMA hopes to have its third funding increase by the state secured by October, at which point it will determine how to allocate its funds among doctors, hospitals, nursing homes and other providers (Heisel, 8/26).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.