ORANGE COUNTY: May Move Uninsured Into Managed Care
In a move that would make Orange County the "first county in the state -- and one of the few in the nation -- to provide universal health care coverage," county Health Care Agency officials are reviewing a consultant's recommendation to shift 300,000 uninsured residents into managed care programs "as soon as possible". The Orange County Register reports that "[m]ost of the county's poor are already in managed care plans through CalOPTIMA, the county's Medi-Cal provider. The proposal would move the rest into managed care, probably CalOPTIMA." Currently, about 28,000 residents receive fully subsidized coverage from Medical Services for the Indigent (MSI), the county's insurance program, although up to 300,000 "can become covered under MSI if they have a medical need." Most eligible county residents only turn to MSI "after an emergency such as a traffic accident, or when they are diagnosed with a chronic illness." It is this population that consultant Carol Goodman recommended enrolling in CalOPTIMA.
More Than They Bargained For
Most major county health care providers and insurers have labelled the idea a "risky proposition" for CalOPTIMA. The proposed shift would cost $80 million, nearly double the $41 million the county already spends for MSI care. CalOPTIMA submitted a proposal in 1996 to cover MSI patients, "but never suggested that it assume full risk for that population." According to Kathleen Crowley, CalOPTIMA's public affairs director, "We said we would take over the administration of the program. Not start a new plan."
Who Will Take The Losses?
The single biggest issue for CalOPTIMA is capitation -- "receiving a fixed amount each month from the county, regardless of what services were used." If MSI patients incur more expenses than CalOPTIMA is reimbursed for, the Medi-Cal program might suffer, according to CalOPTIMA CEO Mary Dewane. She said CalOPTIMA is unwilling to take on this risk until more is known about the population. Physicians have also expressed reservations about taking losses, under a capitated CalOPTIMA payment plan, on treatment provided to poor patients that were once covered by the county. Jon Gilwee, president of the Healthcare Association of Southern California, said, "It's one thing to pull together and take these kinds of losses as a way to support the county, but that circumstance changes substantially when we are expected to incur substantial losses to feed some other company's profits." Mickey Maxwell, director of the county Health Care Agency's office of policy research and planning, "stressed that the report, which was presented to the county Board of Supervisors on Thursday, is only a starting point for discussion (Gordon, 3/13).