“It is our opinion that the information given to Medi-Cal-eligible clients by the state is absolutely insufficient to make an informed choice. Our patients should be entitled to full disclosure of service providers and where services will occur.” Statement from the Imperial County Medical Society
Misinformation, missing information makes choosing a Medi-Cal Managed Care plan difficult
Jessica Montenegro and the tens of thousands of other people who have Medi-Cal in Imperial County are required to make a choice by Oct. 25 between two health care plans because of Medi-Cal Managed Care.
Medi-Cal Managed Care, which has been around for about 25 years, is an organized system of health care meant to make it easier for Medi-Cal beneficiaries to find a doctor that will accept their insurance.
With two companies established to help inform and lead the estimated 35,000 Imperial County Medi-Cal recipients through the process of choosing plans and doctors, there has been much confusion over how to choose and whether the information being presented is even accurate.
“It’s just a shock, I guess,” Montenegro said about having to choose a plan. “I’ve had insurance like that before and it’s not anything to rejoice over.”
Medi-Cal Managed Care is meant to simply organize and deliver health care better; it is not part of the Affordable Care Act, or Obamacare, which has many provisions regarding the quality and affordability of health insurance.
As part of Medi-Cal Managed Care, every Medi-Cal patient is set up with a primary care physician who will provide comprehensive and continuous care to each patient, also known as a “medical home.” Without Medi-Cal Managed Care, every Medi-Cal beneficiary is on their own in finding a physician who accepts Medi-Cal.
The two companies hired by the state to assist have each produced a booklet, both of which were sent out to Medi-Cal beneficiaries to provide them with their options. Because of its quick implementation, the information being presented to Medi-Cal recipients is either incorrect or missing.
Option one, California Health and Wellness, has a number of physicians to choose from. However, several of the physicians listed are no longer working in the county or are retired. Option two, Molina Healthcare of California, has blank pages in its booklet where a physician list should be.
Montenegro admitted she had not looked too carefully at the physician list, but she knows Dr. Benjamin Lehr is retired yet listed as a practitioner in the California Health and Wellness booklet.
“I don’t understand why they would put retired doctors on there and not clarify,” Montenegro said. “People have a right to know.”
A representative from California Health and Wellness responded to these inquiries in a statement.
“A provider directory is completed at a point in time and can include both contracted and prospective providers,” Deane Lane writes in an email. “We are continually updating the directory as changes occur and Medi-Cal beneficiaries can access our website at www.cahealthwellness.com for the most up to date version.”
Lane could not be reached again for further explanation on why retired physicians are listed as potential providers.
Choosing a primary care physician
Calexico resident Elizabeth Martinez said she had a physician chosen for her by a Medi-Cal representative Tuesday.
When she received the two booklets, Martinez said, “I felt like it was weird because it doesn’t make sense.”
“The issue is you don’t start something that’s not ready,” said Thomas Henderson, executive director for the Imperial County Medical Society, an organization that represents about 85 physicians in Imperial County. “In terms of informed choice in the Imperial Valley, this is bad.”
Martinez said she let the Medi-Cal representatives choose the doctor that was appropriate for her and her family even though she does not fully understand Medi-Cal Managed Care or what that means. Martinez said she plans to wait for her new Medi-Cal card, look through the paperwork she receives and hopes to understand it.
Her current doctor is one of the options for California Health and Wellness physicians so she does not have to switch doctors, but not all Medi-Cal beneficiaries are so lucky. If their current doctor is not listed, they are required to choose a new one from the primary care physicians available.
“I find the initial selection to be problematic,” said Imperial County Public Health Department Director Robin Hodgkin, who is part of the Health Leadership Forum, an organization that has taken a leadership role in helping get the county prepared for the implementation of Medi-Cal Managed Care. The list originally sent out was “a snapshot in time that occurred two months ago.”
How Medi-Cal Managed Care got started
About 90 percent of Medi-Cal beneficiaries are in counties in California that have already implemented Medi-Cal Managed Care without any prompting. Some began Medi-Cal Managed Care 25 years ago, while others began their implementation about seven or eight years ago.
However, 28 rural counties including Imperial County had not made that transition on their own.
Two years ago, the California state budget mandated that every Medi-Cal beneficiary enrolled in a fee-for-service program transition to a managed care plan by June 1, 2013. None of the counties were ready so the state pushed the date back and continued to push it back until Nov. 1.
Now the state says they cannot move the date anymore.
California Health and Wellness and Molina Healthcare were required to send the booklets to Medi-Cal beneficiaries on Sept. 1 and the list had to be submitted in August to fit that deadline. Molina Healthcare was only added as a commercial competing plan to California Health and Wellness in August.
“We’ve had a late start,” said Molina Healthcare President Richard Chambers. “The difficulty was that we couldn’t put in anyone we hadn’t contracted with.”
The blank pages in the booklets say, “Molina Healthcare of California is currently building its Medi-Cal Managed Care provider network in Imperial County … Our provider network will continually change as we build our network and add providers.
The pages continue: “For current information about our provider network, please call Member Services between 7 a.m. and 7 p.m., Monday through Friday, toll-free at 888-665-4621 or visit our website at molinahealthcare.com.”
Loreani Guadalupe, a public relations specialist with Molina Healthcare, said she expects the provider network to be online by the end of this week. With Medi-Cal beneficiaries required to choose a health plan by Oct. 25, it doesn’t give them much time to look over the plan and make an informed decision.
If a Medi-Cal recipient does not sign up for either of the plans, one will be automatically chosen for them. The Medi-Cal recipient has the option to change their plan on a month to month basis, if they decide the other plan suits their needs better, Chambers said.
Uncertainties moving forward
The Imperial County Medical Society, which has been involved in the decision-making process for Medi-Cal Managed Care since it was state mandated, gave a statement on its concerns about moving forward:
“It is our opinion that the information given to Medi-Cal-eligible clients by the state is absolutely insufficient to make an informed choice. Our patients should be entitled to full disclosure of service providers and where services will occur.”
The Imperial County Medical Society calls for the state to extend the signup deadline. As of now, Nov. 1 is the expected date for the plans to go live.
The Department of Health Care Services stated, “DHCS has worked closely with the (Molina and California Health and Wellness) to ensure readiness, and both plans in Imperial have demonstrated that readiness. DHCS has also worked closely with the county to keep it well informed of the details of the transition.”
California Health and Wellness recently received a Knox-Keene license, which will allow it to begin serving patients on Nov. 1. The Department of Managed Health Care determines whether a network is sufficient and gives a Knox-Keene license.
Molina Healthcare does not have that license yet and cannot go live without it. There are currently some uncertainties over whether California Health and Wellness will go live alone or if the Department of Managed Health Care will push the date back for both plans.
“They’ve created kind of a messy situation and the state will have to solve that,” Hodgkin said.