Orange County Grand Jury Finds Serious Issues With CalOptima

California Healthline -

The Orange County Grand Jury has released a report raising serious concerns about CalOptima -- Orange County's Medi-Cal managed care plan, the Orange County Register reports. Medi-Cal is California's Medicaid program.

The $1.5 billion CalOptima currently serves 427,000 residents who are young, disabled, elderly or low-income (Galvin, Orange County Register, 1/25).

The number of beneficiaries is expected to increase to 540,000 -- or 27% of Orange County's population -- when the Affordable Care Act takes full effect next year (Wood/Santana, Voice of OC, 1/24).

In 2011, county Supervisor Janet Nguyen -- who joined the CalOptima board two years ago -- allowed lobbyists from the Hospital Association of Southern California to rewrite the ordinance governing CalOptima, giving more control to health care providers and less control to beneficiaries, the Register reports.

The ordinance change also increased the number of county employees who sit on CalOptima's board from one to two.

Report Findings

The grand jury found that CalOptima "appears to be imploding," as the leadership "has been decimated by the departure of 16 senior executives" in the past 18 months.

The report noted that CalOptima "is jeopardizing its membership's access to quality health care and potentially putting the entire entity at risk."

Although the report did not name names, it criticized the move to let CalOptima’s ordinance be revised (Orange County Register, 1/25).

The grand jury also found that a confidential report to the CalOptima board was distorted to make it seem like there were more serious problems with the plan's management than actually existed (Voice of OC, 1/24).

Recommendations

The report recommended that:

County employees be removed from the CalOptima board, since county employees would be "reluctant to vote against a supervisor;" and
CalOptima's board include more than one county supervisor (Orange County Register, 1/25).

The grand jury gave CalOptima 90 days to formally respond to the report (Voice of OC, 1/24).

Response From CalOptima

Michael Schrader -- CalOptima's new CEO -- in a statement said, "I appreciate the interest of the grand jury in the agency, and welcome public scrutiny and review of our operations."

Nguyen disputed the report's findings, saying she was not interviewed as part of the grand jury's investigation and that the report "does not present a complete picture of the facts" (Orange County Register, 1/25).