There Are Options For OC Medi-Cal Patients Affected By State’s Deep Cuts

Picture the groundswell that started late last week after the Governor signed into law California’s new budget: from Yorba Linda to Anaheim, from Santa Ana to San Clemente, the waiting and exam rooms of many Orange County doctors filled with patients worried about cuts, and these were to the bone. Their voices carried a concern about the many benefits eliminated to those with Medi-Cal, the state’s Medicaid program for low income, disabled and the elderly.

The cuts, the result of California’s significant budget shortfall, impact about 300,000 Orange County residents. Podiatry, hearing, vision and dental services, among others, have been eliminated for those receiving their medical benefits from Medi-Cal.

While I empathize with their concern and realize the unfortunate nature of how these cuts will affect their health and lives, there are other options for those seniors and patients with disabilities who are Medi-Cal and Medicare eligible, the result of a coordinated care model that has taken shape over the last several years in Orange County, thanks to organizations like CalOptima, OC’s administrator of Medi-Cal benefits.

More than 55,000 of Orange County’s Medi-Cal members are eligible for both Medi-Cal and Medicare benefits. The federal Medicare program allows communities like Orange County to create special needs plans for those who meet the eligibility criteria for both Medi-Cal and Medicare.

The option to join these special needs Medicare Advantage plans, like CalOptima’s OneCare and others, allow for patients to have their care coordinated by groups of physicians who have made a commitment to care for the most frail and vulnerable members of our community. Monarch HealthCare and other medical groups in OC are comprised of thousands of physicians who have made this commitment to improve the health of these patients.

The good news is that many of the benefits eliminated by cuts to Medi-Cal can be obtained from the Medicare portion of the special needs plans. You merely need to be a member of the plan to receive the benefits. These plans are simple to understand and use, with a central point of contact and coordination.

Moreover, these plans were particularly developed to allow for a medical “home” for Medi-Cal and Medicare eligible patients who have multiple doctors, medications and caregivers. The medical “home” model of care allows us to coordinate all of their care so that it is seamless, requires less paperwork and more importantly, allows us to focus on improving their overall health and well being.

Our physicians joined these plans with enthusiasm and a desire to make a difference. Confident in our ability to serve these patients, these physicians wanted to demonstrate that high quality health care can be delivered to the most medically compromised patients at a lower cost to the State and Federal government. Our physicians and leadership have invested millions of dollars in technology and systems to improve our ability to care for chronically ill patients who demand a high level of coordinated, intensive care, from physician offices to hospitalization and at-home care.

Many of my colleagues around the County have done the same and share a vision for change that today can been a tangible difference in the lives of many of Orange County’s most elderly, disabled and at-risk patients. These special needs health plans were created to provide vital health benefits in a time of need. For many Orange County residents, they may be just what the doctor ordered.

Dr. Bart Asner is Chief Executive Officer of Irvine-based Monarch HealthCare, Orange County’s largest network of physicians with more than 2500 primary care and specialist doctors.