Countywide : Cal-OPTIMA Care Plan Gets Underway

Orange County’s new managed care system for Medi-Cal recipients, Cal-OPTIMA, will begin operation Sunday after months of delays that stemmed from the Orange County bankruptcy and prolonged rate negotiations with the state.

Medi-Cal beneficiaries enrolled with Cal-OPTIMA will be able to access one of 40 health-care organizations throughout the county.

The new system includes traditional Medi-Cal providers as part of a doctor-hospital consortium, as well as health maintenance organizations and other large networks such as UC Irvine Medical Center and Friendly Hills Health Care. HMO participants include Kaiser Foundation Health Plan, FHP International Corp. and PacifiCare Health Systems.

As the county’s answer to problems in the state Medi-Cal program, the Cal-OPTIMA system--the only one of its kind in California--is locally run and is intended to be more cost-effective and provide patients greater access to care. The system is intended to serve about 300,000 recipients.

So far, about 100,000 members have chosen a health plan, Cal-OPTIMA officials said. Those who have not selected a plan yet will receive medical care through a fee-for-service plan provided by Cal-OPTIMA.

Cal-OPTIMA was imperiled financially last year after $2.4 million of start-up funding became tied up in the county’s bankruptcy. Then, early this year, enrollment of health-care providers was postponed for three months until the state commission that determines Medi-Cal reimbursement rates released a schedule of rates, which weren’t received until April.

“We are moving a population into a managed-care program that has not had access to care on a regular basis in the past,” said Mary Dewane, Cal-OPTIMA’s chief executive officer. “Medi-Cal has been a government program, and now we have asked the provider to step up to the plate and design an organized system of care for the poor of Orange County.”