Supervisors Hear Pros and Cons of CalOptima Health Care Program

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A restrained Orange County Board of Supervisors Tuesday listened to the pros and cons of CalOptima, the county’s system of providing health care to the poor, and avoided the rancor of previous discussions.

The board also unanimously voted to appoint Lee Penrose, president and CEO of St. Jude Medical Center in Fullerton, to a four-year term on the CalOptima board of directors. He will fill a vacancy on the nine-member board among the three seats designated for representatives of medical providers.

“As CEO of a faith-based (Roman Catholic) nonprofit hospital, I have a strong interest in advocating for Medi-Cal patients,” he wrote in his resume when applying for the volunteer board position. “As a member of the hospital community, I have an equally strong interest in the health of Orange County hospitals.”

An unexpected plan proposed last month by Supervisor Janet Nguyen to thoroughly change the composition of the board created a political firestorm.

She wanted to permanently give hospitals a seat on the CalOptima board. She also wanted to realign the rest of the membership to severely reduce representation of the poor while giving control to government, medical providers and businesses, possibly including those that sell products to medical providers.

At that time, she strongly criticized the operations of CalOptima, the county organization that provides federal Medicaid and state Medi-Cal services to poor children, their parents, pregnant women and the disabled. Poor men generally don’t qualify for the program’s services unless their children are covered.

Nguyen since has said she will modify her plan and unveil a new proposal later this month.

In the meantime, other supervisors who said they knew little about how the $1.5-billion program works, were given a slide presentation by David L. Riley, director of the county Health Care Agency.

Riley said CalOptima, which serves about 420,000 of the county’s poor, most on the Medi-Cal program, could expand by another 120,000 or more when the new national health plan is scheduled to take effect. Those who can’t afford other forms of insurance would be eligible for medical coverage.

Riley said CalOptima needs to begin planning for the additional caseload. He also said the agency has so many workers from private industry that it doesn’t always understand how to communicate as a government agency.

Failure to communicate seemed to be one of the most contentious issues.

Nguyen said she is concerned by how minutes of meetings are handled. Sometimes relevant minutes of the CalOptima advisory committees aren’t seen by the CalOptima board until after it has acted on an issue, Nguyen said.

There is one advisory committee for providers issues and another for issues of the poor who qualify for CalOptima and groups that represent them.

In answer to questions, Riley and Supervisor John Moorlach, a strong supporter of the CalOptima board, said the agency has used a reserve fund built up over the years to pay doctors and other providers, sometimes for several months, when the state Legislature failed to pass a budget on time.

Payments to providers is the overriding concern of companies that do business with CalOptima. CalOptima officials said doctors are paid within 30 days, more quickly than the state pays doctors in areas where they send Medi-Cal bills directly to Sacramento.

But it’s the amount that doctors are paid that providers said isn’t enough to cover the expanding costs of health care. The financially strapped state is cutting payments to Medi-Cal providers, although not to hospitals. But all providers face an increased caseload that came with the nation’s poor economy and four years of high unemployment.

Penrose, whose hospital is owned by the St. Joseph Health System that runs four hospitals in the county and contracts with CalOptima, said in his resume that implementation of the new national health plan “will be significant throughout our industry and CalOptima will be at the center of many of the changes.”

— TRACY WOOD

 

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