CalOPTIMA Receives Federal Approval for HMO for Dual Eligibles
CalOPTIMA, Orange County's Medi-Cal agency, announced Friday that it has received federal approval to launch a new HMO that will be aimed at county residents dually eligible for Medi-Cal and Medicaid, the Orange County Register reports. The plan, called OneCare, will allow dual eligibles to choose a primary care physician to coordinate all their care (Wolfson, Orange County Register, 7/23).
Some physicians say the plan could diminish patient care and damage their medical practices' finances by moving as many as 50,000 beneficiaries to the HMO.
Doctors said assurance from CalOPTIMA that patients will have a choice was misleading because patients who do not specify a choice by Oct. 31 will be enrolled in OneCare automatically. They also said that the three medical groups contracting with OneCare will run a marketing campaign aimed at dual eligibles.
CalOPTIMA CEO Richard Chambers said OneCare was designed to simplify complicated health care options for the beneficiaries, particularly after the new Medicare drug benefit starts on Jan. 1, 2006. He said OneCare will provide all benefits from one organization.
Kenneth Bell, CalOPTIMA's chief medical officer, said patients could choose to stay with their doctor in a fee-for-service arrangement instead of joining OneCare or they could select a separate commercial Medicare HMO (California Healthline, 7/23).
Chambers said CalOPTIMA is planning an outreach campaign to educate doctors and consumers about the merits of OneCare, noting that he perceives physician opposition to be decreasing.
However, some doctors and critics said they remain opposed to the new HMO, particularly the expected Oct. 31 cutoff date for choosing a plan. The deadline still must be approved by the federal government (Orange County Register, 7/23).
Additional information on the Medicare drug benefit is available online.