Orange County’s health insurance plan for the poor and elderly, CalOptima, is in the midst of an intense self-questioning as the agency attempts to create medical teams that will treat homeless people on the streets and provide recuperative care housing.

The debate has gone public just as the agency is requested to appear next month at a federal court hearing on homeless policies.

The CalOptima board of directors had some disagreements this month about the legality of using funds to help homeless people with various types of housing, how to implement such efforts as well as the pace of rolling out the medical program.

The discussion drew the ire of County Supervisor Andrew Do, who sits on the nine-member board. Do said CalOptima has been too slow getting services to homeless people throughout the county and the board should focus on that first.

“You tell me, how do we defend ourselves in the court of public opinion or a legal courtroom? I can’t work this way, I really can’t. I wasn’t going to speak up because I don’t know where to start. But I have to put this on the record because at some point we can’t continue to slow roll this thing anymore — I won’t stand for it,” Do said at the March 7 board meeting.

It was time to enter crisis mode, Do said.

“I’m telling you, I’d like for us to sound the alarm. It’s time for us to move and move quickly,” he said. “It’s time this board take the leadership and tell staff what to do or else somebody else is going to do it for us.”

March 7 was the first time the board met since its emergency Feb. 22 meeting when it unanimously voted to create medical teams for the homeless. The move was the result of U.S. District Judge David O. Carter speaking with CalOptima executives and board Chairman Paul Yost. Carter oversees lawsuits against the County of Orange and five South County cities over policies that criminalize the homeless. Although CalOptima isn’t named in the lawsuits, the agency, along with all 34 OC cities, is requested to appear in Carter’s courtroom April 2.

CalOptima Director Ron DiLuigi responded to Do and said while CalOptima needs to act, it should be cautious.

“It’s a crisis for us too. Again, what we do, how we go about it, really does require a level of thoughtfulness on our part,” DiLuigi said, while also pressing Do for specifics. “What are you talking about? What is it you want to do?”

Do, through questioning staff, found the agency received letters of interest from Federally Qualified Health Centers (FQHC) and not the contracts, as was previously believed. CalOptima, through partnering with the health centers, will get reimbursed for medical services provided to homeless people who aren’t CalOptima members. The agency is also looking to set up health centers at the bigger homeless shelters, like the County-run Courtyard shelter in Downtown Santa Ana.

“Last time we were told, that the clinics, we had contracts ready to roll. Do we have all those clinics yet?” Do asked.

“We have letters of interest,” CalOptima CEO Michael Schrader said.

“You starting to see what I’m getting at?” Do said, looking to the rest of the board. “So we think we have all these actions going, but they’re all just preliminary — we haven’t done anything yet.”

In an attempt to get the medical teams on the street faster, the board created an ad hoc committee including Do and OC Health Care Agency (HCA) Director Richard Sanchez, who is also on the board.

“It’s been two weeks since our special meeting tomorrow, that’s not a huge amount of time … how can we make it go even faster, how can we do that?” Yost asked Schrader.

Schrader said the teams could hit the streets by early April.

“They need time to ramp up and do whatever they need … both parties are working together and I think we’re looking at an April 1 date to go live — so five weeks,” he said.  

Sanchez urged Schrader to work with the HCA staff because of its experience in dealing with the homeless population and the work they did during the 2018 Santa Ana Riverbed homeless camp evictions.

Coroner data shows the number of homeless deaths in Orange County skyrocketed, from 53 deaths in 2005 to 164 deaths in 2015, to more than 250 deaths in 2018 – a fourfold increase. In San Diego County, which has roughly the same population as OC, 111 homeless people died in 2018, reported the San Diego Union Tribune.

According to the most recent U.S. Census Bureau estimate, OC’s population is nearly 3.2 million people and San Diego County has 3.3 million people.

A Fullerton Catholic parish priest, Father Dennis Kriz’s Voice of OC opinion articles apparently prompted Carter to file an emergency request Feb. 19 to the Coroner’s office for homeless people’s causes of death in 2018 and 2019.

Father Kriz, who runs a small homeless shelter at his Fullerton church nightly, listed the names of 257 homeless people who died in 2018, using data collected from the Sheriff-Coroner’s office and homeless service providers.

Carter oversees a lawsuit originally filed against the County, Anaheim, Orange and Costa Mesa stemming from the Santa Ana Riverbed homeless camp evictions in January 2018. Attorneys for the homeless people, Brooke Weitzman and Carol Sobel, argued the move “criminalized” homelessness because people were pushed to city streets where they were ticketed for camping and loitering. The three cities have since settled out of the lawsuit, contingent on building shelter beds.

Five South County cities were brought into the lawsuit Feb. 27 when Sobel and Weitzman, on behalf of homeless people, sued Irvine, Aliso Viejo, Dana Point, San Juan Capistrano and San Clemente for allegedly using similar policies to criminalize the homeless. Carter is also presiding over that lawsuit.

According to preliminary numbers from the biennial Point in Time Count conducted by the County and homeless service providers in late January, at least 3,400 homeless people sleep on the streets of OC. Official numbers are expected to be released in April.

“It’s time this board take the leadership and tell staff what to do or else somebody else is going to do it for us,” Do said.

Director Lee Penrose wanted to hammer out “strategic planning” details for the street medical teams and recuperative care housing, but DiLuigi warned the board it should simultaneously roll out the plan and iron out details.

“We all better be able to figure out how to walk and chew gum very quickly,” DiLuigi said. “It would be good for the board to acknowledge and recognize and say this is crisis — it’s urgent.”

CalOptima Vice Chairman Nikan Khatibi asked what the agency’s biggest hurdle to housing was.

Do said the issue is more complicated than the “housing first” model because many people aren’t used to sleeping indoors and cited the 2018 Santa Ana Riverbed evictions and subsequent motel rooms provided to homeless people who were cleared out. He said the Baymont Motel in Anaheim, which provided roughly 100 rooms to homeless people, costed the County $2.7 million because of damage to the rooms from flooding, molding and people generally not following the County’s rules. He also noted community pushback from past attempts to house homeless people in concentrated areas.

“So it’s a lot more complicated … than that mantra you hear all the time, housing first — ‘Use housing first, idiot.’ Like I couldn’t understand housing first, what it means. But until people do it, they have no clue what it means,” Do said.  

Spencer Custodio is a Voice of OC staff reporter. You can reach him at Follow him on Twitter @SpencerCustodio.

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