Medi-Cal Commission Discusses Concerns With Gold Coast Health Plan

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On Monday, patients, patient advocates and health care providers attending a Ventura County Medi-Cal Managed Care Commission meeting expressed concern about Gold Coast Health Plan, the Ventura County Star reports. Medi-Cal is California's Medicaid program (Kisken, Ventura County Star, 3/26).

Background

Gold Coast Health Plan administers Medi-Cal to more than 100,000 Ventura County residents who are low-income or who have disabilities.

The plan launched in 2011 as an HMO-style alternative for certain Medi-Cal beneficiaries.

Recently, the California Department of Health Care Services requested an audit of the managed-care plan after receiving complaints about late payments and poor management.

A preliminary report from the Berkeley Research Group found that actual costs for Gold Coast Health Plan at times have been higher than reported expenses. The findings have raised concern among state officials about the plan's solvency.

The report also noted that that "operations may be negatively impacted" because of turnover of management staff.

Members of the Medi-Cal managed care commission -- which oversees the health plan -- said that the report is a work in progress and that the audit of the plan has not yet been completed.

Commission members added that financial reports show that Gold Coast generated an $8.4 million profit through February.

They also said some of the problems identified in the Berkeley Research Group report already are being addressed (California Healthline, 3/26).

Meeting Details

Meeting attendees voiced several concerns, including that the Gold Coast plan:

  • Is behind on payments to health care providers;
  • Has limited accessibility for Spanish-speaking patients; and
  • Should be more transparent in its actions and release documents that are considered public records.

Matthew Steinorth of Epiphany Care Homes -- which provides care for patients with developmental disabilities -- said Gold Coast is as many as eight months behind in its payments to the organization, which equates to "hundreds of thousands of dollars" still unpaid.

Ken Dixon -- an account executive at Affiliated Computer Services, the Xerox-affiliated company that manages Gold Coast's claims processing -- said it would work to correct the problem. However, Dixon said the claims backlog has been reduced significantly, noting that only 15 claims in the system are more than 30 days old (Ventura County Star, 3/26).


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