For months, Orange County Supervisor Janet Nguyen has triggered deep concerns among CalOptima officials and local health care nonprofit leaders by proposing changes to the board of directors overseeing the county’s $1.3-billion managed health care program for the county’s low-income residents.

On Tuesday, Nguyen made sure she’ll be part of the debate for a while.

In a 3-2 vote, with supervisors Shawn Nelson and John Moorlach dissenting, the board not only approved changes that increase health care industry representation on the board but also extended a supervisor’s term on the board from one to two years. Nguyen is the supervisors’ current representative.

The vote was a victory for Nguyen, who has been highly critical of CalOptima in recent months and pushed hard for changes to the board.

The changes are particularly frustrating to other CalOptima board members and nonprofit health care providers because neither Nguyen nor the county staff has offered specific reasons for reforms.

Nguyen meanwhile insists that during her first 11 months as the supervisors’ representative she has received many consumer complaints, though she hasn’t offered specifics.

“Despite what you hear or read in the papers, the complaints are there,” Nguyen said. She acknowledged that the agency “has good employees and does a good job.”

The changes approved yesterday expand the CalOptima board by two seats — one for a public member and another for the county Social Services director — and also affect current seats, such as giving hospital associations a permanent seat on the board.

Since first raising her concerns, Nguyen and county staff had considered abolishing the agency, calling for a grand jury probe or even asking every supervisor to serve on the agency.

Nguyen declined to take such aggressive options, saying her changes to the CalOptima board would allow it “to evolve with the current changing climate.”

But she did make a pre-emptive move against Moorlach, who is expected to take over as chairman of the Board of Supervisors in 2012. By securing a two-year term she prevented Moorlach, with whom she’s clashed in the past, from being able to control who serves on the CalOptima board.

It is now the only supervisorial appointment that requires an independent vote of supervisors. All others are proposed by the chairman and ratified by other supervisors.

Moorlach, who was the county’s representative on the CalOptima board before Nguyen, has disputed her contention that the agency has significant problems.

He reiterated his stance Tuesday. “Since there’s no presentation today, I want to figure out where are the problems,” he said.

“I was very engaged [on the CalOptima board],” Moorlach said, “but I have no recollection of any serious complaints. This organization has been running like a watch.”

Ed Kacic, current chairman of the CalOptima board, told supervisors that the ordinance change give the “implicit feeling that there’s some significant things wrong with CalOptima.”

Kacic testified against Nguyen’s proposal, telling supervisors that CalOptima had very low administrative costs and spent more than 95 percent of its resources on health care. Audits of the agency have been clean the past four years, Kacic said.

He also gave county supervisors an indication of what might be driving pressure from the health care industry to add more hospitals and other providers to the board.

“We are severely underfunded, which means we are not the high payer in the health care business,” said Kacic.

While Nelson told supervisors he didn’t have issues with Nguyen’s tinkering with CalOptima, he did take issue with her changing the appointment process.

“I don’t get involved with CalOptima. … If there’s a better way of doing it, so be it,” Nelson said.

Nelson called Nguyen’s changes to the appointment process a “Trojan horse,” saying that changing board terms as well as the method of appointment is a “bad business practice” that “encourages subterfuge.”

“I don’t want to be involved in that,” Nelson said. “We should not be supporting bad business policy because we want to coddle one of our own.”

Moorlach also criticized the idea of adding two more seats on the board, saying smaller is better for governing boards. He also directly put county Social Service Director Michael Riley, who was in the audience, on the spot, saying, “Michael Riley said he has never asked to be on board.”

“This is a solution looking for a problem,” Moorlach said.

Supervisor Pat Bates was supportive of Nguyen’s motion, saying boards like CalOptima require a lot of specialized knowledge and a two-year term is a good idea.

“It is very complex in all that it deals with,” she said. “It makes sense.”

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