Hospital Considers Withdrawal From Medi-Cal Managed Care Plan
Western Medical Center-Santa Ana on Friday announced that it would withdraw from CalOptima, Orange County's Medi-Cal managed care plan, in six months if higher reimbursements are not negotiated, the Los Angeles Times reports.
The hospital is one of seven primary hospitals that contracts with CalOptima to treat Medi-Cal and Healthy Families beneficiaries. Western Medical treats about 4,300 CalOptima members annually.
Hospital CEO Dan Brothman said CalOptima pays the hospital about $900 daily to treat at least 12 members each day, a rate he says does not cover the costs of treatment.
CalOptima CEO Richard Chambers said the managed care plan also had financial issues, noting that for the last three years it has run a deficit and used financial reserves to offset the difference between Medi-Cal payments and treatments. He said a recent $50 million payment from the state as part of a rate adjustment improved CalOptima's financial outlook (Reyes, Los Angeles Times, 2/25).