Feds To Lift Enrollment Freeze on CalOptima Program

Federal authorities will lift an enrollment freeze on CalOptima’s troubled OneCare program in November, the first of a number of steps the agency must take after auditors found widespread and systemic problems in the program serving 15,000 disabled and elderly patients.

New patients will be able to enroll in the OneCare program again on Nov. 1 following a nine-month freeze ordered by the federal Center for Medicare and Medicaid Services after its auditors found a number of compliance issues that together posed a “serious threat to the health and safety” of participants. 

The results of the federal probe prompted state examiners to conduct their own, more extensive audit this spring.

The state audit found potentially dangerous delays in approving prescriptions, the lack of a system to detect potential fraud and abuse, and no monitoring of providers to track how they handled referrals.

Although CalOptima has the go-ahead to re-open, the agency still needs to pass a federal re-audit in January and a joint review by state and federal authorities in order to participate in a new program called CalMediconnect, which expands the former OneCare plan and is lucrative for medical providers.

Orange County is one of eight pilot counties for the statewide project, which is slated to begin in July.

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