County’s CalOPTIMA Program Gets Underway : Health: Registration packets are being sent to residents on Medi-Cal, 300,000 of whom system will eventually serve following its Oct. 1 debut.

The first sign-up packets have been mailed and enrollment has finally begun in CalOPTIMA, the new health-care system designed to serve many of Orange County’s poorest residents.

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Officials of CalOPTIMA, a $400-million program that will debut Oct. 1, sent enrollment packets last week to about 56,000 households, or 190,000 potential participants, agency spokeswoman Kathi Crowley said Wednesday.

Already about 4,000 enrollment forms have been returned, Crowley said.

“We are off to a great start and are delighted with the response to date,” Crowley said. “Of course, we anticipate some falloff, but we will continue our community outreach effort to get the bulk of our population enrolled.”

When the program runs at full strength sometime next year, an estimated 300,000 county residents, all qualified for Medi-Cal, will take part, Crowley said. Funding for the program will come from current Medi-Cal sources--the state and federal governments.

Enrollment is being done in stages, with this first segment targeting county residents who qualify for the state’s Aid to Families with Dependent Children program.

Starting Feb. 1, the second phase of enrollment will focus on another 100,000 people, among them many of the county’s aged, blind and disabled residents.

One of the main challenges now is to get the word out that CalOPTIMA can help qualified recipients and get them to respond, said Mary Dewane, the chief executive officer of CalOPTIMA.

“We are all waiting to see to what extent people will take the initiative and enroll,” said Dewane. CalOPTIMA officials are prepared to continue their outreach programs to make sure potential recipients get the word.

“We anticipate there will be a set of people who will, perhaps like all of us, allow the enrollment packet to remain on a desk unopened,” Dewane said. “I think it is those we want to make sure we outreach to a second and third time. . . . “

CalOPTIMA, a nonprofit health management organization for Medi-Cal recipients, was created in 1992 in response to what local officials considered to be a public health care crisis.

Delivery rooms and emergency rooms were overloaded, and the county’s poorest residents could not find physicians who would treat them, Crowley said.

Until CalOPTIMA, the county Medi-Cal community has operated on a fee-for-service system, where recipients search for a physician to treat them and then bill the state for medical care. That system has been described as cumbersome, inefficient and relying too heavily on emergency rooms for basic health care.

“What CalOPTIMA will do is change that process,” Crowley said. “This Medi-Cal community will be covered by managed health care and CalOPTIMA will serve as the contractor and work with the health care providers.

“What we are trying to do at the local level,” she said, “is incorporate some private sector solutions to a government program.”

CalOPTIMA is considered a revolutionary system being tried in five California counties. Santa Barbara was the first county to embark on the experiment. After 12 years, the $80-million Santa Barbara Health Initiative has become the role model for similar programs in Orange, San Mateo, Solano and Santa Cruz counties.

CalOPTIMA is run by a seven-member board of directors.

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Care Packages

During the next several months, Orange County Medi-Cal recipients will receive information packets regarding Cal-OPTIMA health insurance benefits. A program outline:

* Eligibility: Most Medi-Cal beneficiaries in Orange County

* First step: Return enrollment packet to select health plan, doctor

* Enrollment: First phase underway, second phase begins in February

* Coverage starts: Oct. 1

* Potential participants: 300,000

* Information: (714) 246-8400

Source: Cal-OPTIMA