CalOptima Board OKs Increase in Reimbursements for Specialists
Last week, the board of directors for CalOptima -- Orange County's Medi-Cal managed care plan -- voted to spend an additional $10 million annually to increase reimbursements for specialists, the Orange County Register reports.
Medi-Cal is California's Medicaid program.
Officials hope the payment increase will dissuade specialists from dropping Medi-Cal patients (Reicher, Orange County Register, 10/4).
Background on CalOptima
CalOptima serves 427,000 residents who are young, disabled, elderly or low-income.
The number of beneficiaries is expected to increase to 540,000 -- or 27% of Orange County's population -- when the Affordable Care Act takes full effect next year (California Healthline, 1/28).
Details of Plan To Increase Reimbursements
The additional spending will go toward an 8% pay increase for specialist providers, such as:
- Ophthalmologists; and
- Other doctors.
CalOptima officials said that the funding comes from $13 million in unexpected Medi-Cal revenue.
Javier Sanchez -- chief network officer at the managed care plan -- said there will be "more competition to access these specialists" after the ACA is fully implemented, suggesting the need to keep such providers in the program.
However, Peter Anderson - director of Fountain Valley Regional Hospital's emergency department -- said that health care networks could choose to distribute the higher reimbursements unevenly, granting higher payments to specialists who are in higher demand.
Executive Bonuses Approved
Meanwhile, the CalOptima board also approved bonuses for two top executives.
The board approved:
- A $27,000 one-time payment for Michael Schrader, the plan's CEO; and
- An $8,000 raise for Gary Crockett, the plan's chief counsel (Orange County Register, 10/4).