Medi-Cal Officials Assess Gold Coast Health Plan's Assignment Procedures

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The Ventura County Medi-Cal Managed Care Commission has formed a committee to study how beneficiaries covered by Gold Coast Health Plan have been assigned to clinics and physicians, the Ventura County Star reports. Medi-Cal is California's Medicaid program.

Concerns about the assignment process were raised in a draft report by an external auditor.

Commissioners said they will not be able to assess the implications of the plan's assignment procedures until they obtain more information on how and why beneficiaries were directed to certain health care providers (Kisken, Ventura County Star, 3/31).

Background

Gold Coast Health Plan launched in 2011 as an HMO-style alternative for certain Medi-Cal beneficiaries. The plan administers Medi-Cal to more than 100,000 Ventura County residents who are low-income or who have disabilities.

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 (California Healthline, 3/27).

Assignment Procedures

When the program began, about 67,663 of the more than 100,000 beneficiaries receiving coverage from Gold Coast needed to choose a primary care physician, according to records. However, about 47,000 of them did not choose and were assigned to physicians and clinics.

Former Gold Coast CEO Earl Greenia -- who resigned in March -- worked with a committee to establish auto-assignment procedures.

He announced that safety-net systems -- including county clinics, Clinicas del Camino Real and several Community Memorial Centers for Family Health -- would be assigned three beneficiaries for every one assigned to clinics that serve Medi-Cal beneficiaries but do not meet safety-net qualifications.

ACS, a contracted company, administered the assignment process.

Criticisms of Assignment Procedures

Since the launch of Gold Coast, leaders of clinic systems have complained that many of their existing patients were assigned to other systems. They said that in some cases members of the same family were directed to different clinics.

Clinicas officials complained that the procedure took away thousands of its patients, despite that the auditor's draft report found that the assignment process moved 1,681 beneficiaries to Clinicas in September 2011.

Tony Alatorre, chief operations officer for Clinicas, said the system was "cheated," adding that the number of Medi-Cal beneficiaries assigned to Clinicas decreased from 25,000 before the Gold Coast launch to about 11,800 in July 2011. The system's enrollment has since grown to about 16,000, according to Alatorre.

According to the auditor's draft report, the assignment procedures appear to favor the Ventura County Health Care Agency's clinic system. The report found that Greenia changed the assignment process in September 2011 so that physician assistants, nurse practitioners and residents training at Ventura County Medical Center qualified as health care providers.

Clinicas officials said they were told physician residents would not be included in auto-assignment procedures. They said that the change meant even more beneficiaries were moved to Ventura County Health Care Agency facilities instead of Clinicas or Community Memorial Health System.

Responses to Criticisms

Ken Dixon, ACS representative, said that the assignments were based on orders from Greenia.

Greenia said his decisions were prompted largely by the number of physicians and other providers at different clinic systems.

He added that the safety-net clinics were assigned about seven beneficiaries for each beneficiary sent to a non-safety-net system, noting that safety-net health care providers were assigned more beneficiaries than originally expected (Ventura County Star, 3/31).


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