Critics Drop Bid to Derail Medi-Cal HMO Pilot Plan

SACRAMENTO â€”  Legislative opponents of a proposed Medi-Cal pilot project in the San Fernando and Santa Clarita valleys said they have abandoned their attempts to push a bill through the Legislature to derail the program before lawmakers go home for the year on Sept. 13.

Project critics said they have encountered two problems: opposition from some Valley lawmakers and procedural roadblocks that make it difficult to introduce a new bill at this late hour in the legislative session.

Project opponents said they plan instead to spend the months before the program begins early next year trying to persuade the Deukmejian Administration to modify the proposal.

If their efforts fail, “we’ll come back in January� to the Legislature, pledged Assemblyman Richard Katz (D-Sepulveda) in an interview this week.

Under the program, known as Expanded Choice, most of the 87,000 elderly and poor Medi-Cal recipients in the San Fernando and Santa Clarita valleys would be required to sign up for one of a handful of health maintenance organizations (HMOs) approved by the state.

Program Contains Restrictions

The program, which also will be instituted in San Diego, will curb the ability of Medi-Cal recipients to visit their personal physicians, their neighborhood pharmacists or the hospitals of their choice and require them to seek treatment only at one of the HMOs.

The program is scheduled to begin Jan. 1, but Medi-Cal recipients will have until March 31 to sign up with one of the participating HMOs.

The plan is strongly backed by Gov. George Deukmejian, who hopes the concept will be adopted statewide.

Critics contend that the program will not meet the state’s goal of saving 5% a year in Medi-Cal costs. And they say the project will disrupt medical treatment for the poor and elderly.

For instance, Sen. Alan Robbins (D-Van Nuys) said that a person with a chronic disease who is being treated by a specialist will be unable to continue with him unless the physician belongs to the patient’s HMO.

“You just can’t walk into a health maintenance organization office and expect to be treated� if the specialist is not signed up in the program, Robbins said.

Robbins had planned to introduce a measure aimed at scuttling the pilot program. But this week Robbins said he could not persuade all other members of the Valley delegation to go along with his proposal and decided to drop it.

In the wake of Robbins’ decision, Katz said he plans to seek changes in the system by lobbying the Deukmejian Administration.

Deprived of Family Doctor

“What it (Expanded Choice) does to the seniors is take them away from the doctor they’ve been going to for years,� Katz asserted.

Assemblywoman Cathie Wright (R-Simi Valley), said Robbins did not approach her to support his proposal to derail the program but indicated she would have turned him down if he had.

Wright said she supports the goal of Expanded Choice. “What we’re trying to do is find ways to give people the proper service under the Medi-Cal system without the costs that have been involved.�

She added that rising costs could undermine future legislative support for Medi-Cal.

Sen. Ed Davis (R-Valencia) also is a vocal supporter of the pilot project.

In response to concerns expressed about Expanded Choice, the program director has written a letter to Wright to reassure her constituents that there will be a minimum number of disruptions in treatment.

The director, James C. Foley, cautioned that the state will attempt to “contract with health plans that involve existing Medi-Cal providers.

“We are also developing criteria to enable beneficiaries with continuing medical treatment needs to request exclusion from the program.

“It is our belief that these two efforts will result in minimum disruption of existing beneficiary-provider relationships.�

In an interview Friday, Foley said 16 groups have obtained applications to become participating HMOs. The deadline for returning them is Friday.

But some critics say that many questions about Expanded Choice remain unanswered.

“We do not think the program should be implemented until the details are worked out,� said Geraldine Dallek, an analyst with the National Health Law Program in Los Angeles. The program is financed by the National Legal Services Corp. to assist lawyers counseling the poor on health care.

Dallek said it still is unclear who will be exempted from the program or what the state plans to do to prevent underuse, a problem that has plagued similar programs elsewhere.