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Medi-Cal Pilot Program to Be Postponed

November 21, 1985|MARK GLADSTONE and LYNN O'SHAUGHNESSY | Times Staff Writers

SACRAMENTO — The start-up of a much-criticized Medi-Cal pilot project will be delayed by as much as five months, chiefly because of a snag in awarding a key contract, members of the commission overseeing the experiment said Tuesday.

Commissioners said the earliest that enrollment in the program could begin is April 1. Originally, the providing of health services was to have begun by then. Now, commissioners said, health-care services under the program will not start until sometime between July 1 and Sept. 1.

'It's clearly going to be delayed," said Michael W. Murray, executive director of the state Medical Assistance Commission. But the commissioners said they still are confident that the experimental program, known as Expanded Choice, will be implemented.

Designed to Lower Costs

Under the program, 87,000 poor and elderly Medi-Cal recipients in the Glendale and San Fernando and Santa Clarita valley areas will be required to join a participating health maintenance program. They will no longer be able to visit their own physicians or pharmacists.

Expanded Choice will also include 165,000 Medi-Cal clients in San Diego County.

The program was designed to lower the cost of providing health care to the poor and elderly. Enrollment originally was scheduled to begin Jan. 1, but the commission earlier this month pushed the date back to Feb. 1, saying its small staff could not handle the workload.

State officials gave differing estimates of the latest delay.

Richard T. Silberman, commission chairman, said that enrollment, in which Medi-Cal recipients will pick HMOs, probably will begin in April and that health care could be provided starting in July.

But John Rodriguez, a non-voting member of the commission who represents the state Department of Health Services, predicted that it would take at least until September to begin to provide HMO services for Medi-Cal recipients.

'We're Talking Summertime'

"It's clear that if we want to do this right . . . we're talking summertime," Rodriguez said.

Rodriguez said the main reason the timetable is up in the air is that the health department will not seek bids until next month for a contract worth $1 million to $2 million to provide enrollment services to Expanded Choice participants in the affected areas of Greater Los Angeles and San Diego.

The bidder selected will prepare brochures explaining the options available to Medi-Cal recipients, arrange meetings to discuss the options and develop a computer program cataloguing HMOs participating in the program.

On Tuesday, the commission adopted a timetable that calls for choosing by mid-December the HMOs that will provide care in the San Diego program, with enrollment starting in April and service in July.

The commission scheduled selection of HMOs for the Glendale and Valley areas program for Feb. 4. But commissioners left open the schedule beyond then.

Rodriguez suggested that the commission may have underestimated the massive start-up task. "When the original date of April was set, and that was set a long time ago, no one had sat down and done a complete work plan on all of the things we have to get done," he said.

Target of Criticism

The Expanded Choice project has been the target of criticism from the time it was proposed. Representatives of Medi-Cal recipients have complained that it would limit the choice of participants and disrupt existing patient-physician relationships. Some physicians and pharmacists who treat Medi-Cal patients have complained that they would be excluded under the HMO plan.

Last week, Assemblyman Richard Katz (D-Sepulveda) said he would ask the state's legislative analyst to assess the financial feasibility of the project so lawmakers could determine if it should continue.

Barbara Samuels, a leader of a coalition formed by 20 San Fernando Valley professional, civic and social organizations last month to block the Medi-Cal project, said Tuesday that she was "delighted they've postponed it because there is a recognition they have gotten into something they can't handle."

Mark Gladstone reported from Sacramento and Lynn O'Shaughnessy from Los Angeles.

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