After a year of protests by consumer advocates, brake-slamming by federal officials and hurried fixes by the state, Los Angeles County today begins its foray into mandatory managed care for most Medi-Cal recipients..
For hundreds of thousands of beneficiaries, the change, phased in over six months, means choosing a managed care plan or being assigned to one. For this impoverished population, the old system of shopping for willing Medi-Cal providers--an increasingly frustrating endeavor that often landed beneficiaries in emergency rooms--is being scrapped.
The new system, with estimated annual expenditures of $800 million once in full gear, will pay doctors and plans set monthly fees to take care of the range of medical needs for patients assigned to them. Patients will have a choice between two competing plans, locally organized L.A. Care and the commercial organization Foundation Health. Both of the plans are composed of HMOs. The idea is to control costs while expanding patients' choices.
The concept of managed care for the poor has its detractors, who are fearful that an often transient and disenfranchised population will not easily navigate the system. But it is the sheer magnitude of the transition that has drawn the greatest concern from consumer groups and many physicians. Los Angeles County's program, which has been operating on a voluntary basis since April, will be by far the state's largest such undertaking--and one of the most ambitious in the nation.
Some health-care experts say the success or failure of the so-called "two-plan" approach to Medicaid managed care in California, though it is set to be implemented in a dozen counties, will be judged largely by its performance in Los Angeles County.
Starting today, about 140,000 beneficiaries a month will be added to the managed care rolls, whether by choice or so-called "default assignment." By midyear, more than 1 million enrollees are expected.
Is the county ready for this?
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That depends on who you ask. State health officials, jolted repeatedly this year by federal regulators' demands to improve beneficiary outreach and erase confusion, say they are in good shape.
"We have gone a long way down the road to make sure people have enough information," said Walter Barnes, assistant chief in the state's Medi-Cal managed care division.
