There’s a big problem around the corner for Orange County’s health plan for the poor, agreed many CalOptima leaders at their monthly board meeting last week. 

Gov. Gavin Newsom’s termination of the state’s COVID-19 health emergency declaration could effectively cut off health care for thousands of low-income children, seniors and disabled people with chronic conditions in OC. 

“I think we really are underestimating the impact it’s going to have,” said Dr. José Mayorga, a CalOptima Board Director in charge of UCI Health. “And for us that are in the clinic, seeing the patients – the last thing you want to do is turn people away, or not get them referred timely to receive services from specialists, or imaging, or surgeries.”

The state’s emergency declaration in part kept people enrolled in the state’s low-income health program, MediCal, despite disqualifying income increases. Now it will end, with eligibility reviews set to resume in April.

It would cut the number of CalOptima-covered people by about 13-15%.

As many as 146,000 people, give or take.

That could mean 146,000 people turned away from things like surgeries and chronic health care, according to the agency’s most recent membership data.

The health plan’s current total membership counts 973,571 OC residents, according to the agency’s most recent data.

According to the 2020 Census, roughly 3.2 million people live in Orange County.

Meanwhile, in an idyllic region with a lofty cost of living, new enrollments are only expected increase over time – averaging about 8,000 new people each month, and “averaging” 906,000 members by the next budget cycle, said CEO Michael Hunn at Thursday’s meeting.

It will be up to the agency to ensure the smallest disruption to enrollments as possible, through community outreach and contracts for navigator services, said CalOptima’s Chief Operating Officer, Yunkyung Kim. 

“We’re underway with the hiring and the training of additional resources in our community.”

Dr. Clayton Chau – the OC HealthCare Agency director who sits on CalOptima’s board – wondered aloud whether Hunn, the CEO, could lobby the state for a “tiering” process for patients in active care to come up last for potential disenrollment.

“I’m most concerned about people who have chronic health conditions that are currently, actively participating in care,” said Chau, who wondered about those who are enrolled but not utilizing care – and whether the state could “tier those people first.”

The agency’s investing $6 million to fund up to 100 community-based healthcare navigators and a robust public awareness campaign, said Sharon Dwiers, the clerk for CalOptima’s board directors, in an emailed response to questions. 

At the same time, the county Social Services Agency will incorporate a statewide “system upgrade” to the software used to determine MediCal eligibility, Hunn said. 

He added that the Social Services Agency’s director, An Tran, “will have to be training 3,000 of his staff on this new system while beginning redetermination and eligibility.”

“This is not going to be in-complex.”

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