Friday, October 7, 2011

CalOptima members seek voice on board, Medi-Cal suit affects OC

*This article was originally published in the Viễn Đông on 7 October 2011. It was reported by Vanessa White.

SANTA ANA, California—As Medicaid recipients await a U.S. Supreme Court decision, possibly allowing them to sue California over Medicaid reductions, a local Medicaid insurer could see changes in the voices heard on its board.
Medi-Cal is California’s version of federal Medicaid. CalOptima, Orange County’s (OC) public health plan, provides coverage to over 400,000 lower-income people under programs, including Medi-Cal.
Such people’s voices are not always heard on CalOptima’s board, according to speakers of the public at an OC Board of Supervisors meeting on 4 October 2011.
And it’s not necessarily that board members do not want such voices heard.
Ms. Jean Forbath, who said she was instrumental in molding CalOptima even before its inception in the early ‘90s, told supervisors that it’s difficult to find consumer board members who have the time necessary to be active on the board.
A consumer board member is a board member receiving health care services from CalOptima or another health care insurer.
Ms. Forbath continued, saying that consumer board members do not often last very long on the board, as it can be intimidating for them to be on the board with other members in powerful positions of authority.
There are currently three seats open to consumer members or organizations representing CalOptima consumers on the CalOptima board. In total the board has nine seats, one of which is also open to a BOS or a BOS alternate.
First District Supervisor Janet Nguyễn came under criticism before and during the meeting for her role in proposing amendments that would give her, as First District Supervisor, a permanent spot on the board.
Amendments to Health Care Agency ordinance
The other five CalOptima board seats are open to the director of the OC Health Care Agency (OCHCA), one physician, two other health care providers, and a member from the business sector who doesn’t qualify for any of the other seats.
There is currently a vacancy in one of the provider representative seats.
Under the new proposal, which Supervisor Nguyễn publically introduced at the meeting, the supervisor in the supervisorial district with the highest number of people enrolled in CalOptima should have a spot on the board, as well as another supervisor to sit as an alternate.
Supervisor Nguyễn's First District, consisting of Garden Grove, Westminster, the Northern part of Fountain Valley, and Santa Ana, has the highest number of people enrolled in CalOptima.
Also under the proposal, an extra seat could be open to a person from the OC private business sector, while only one seat open to a CalOptima consumer or an organization representing CalOptima consumers.
Ms. Adriana Moreno, program director for at the Children’s Health Initiative of OC (CHIOC), told the BOS at the meeting that she was appointed to the CalOptima board six months ago and serves on the consumer seat.
Echoing what Ms. Forbath told the BOS earlier, Ms. Moreno said it could be intimidating sitting on CalOptima’s board. Yet, it was also an honor.
She asked the BOS to not limit the consumer voice to one person on the board.
There were other CalOptima members who addressed the BOS, saying they wanted less government on the board, more physician and consumer representative voices.
They also said they were not given enough time to consider the proposal, some of them less than one week.
Fourth District Supervisor Shawn Nelson specifically took issue with Supervisor Nguyễn being “entitled” to sit on CalOptima’s board because her district has about 40 percent of OC’s CalOptima enrollees.
By the end of the discussion, Supervisor Nguyễn received a 4-1 BOS vote backing her motion to address the board with a presentation this month on the basics of CalOptima.
She also said she will provide a better proposal with more input from CalOptima’s members and stakeholders, sometime in November.
Medi-Cal lawsuit, executive bonuses
CalOptima members face more uncertainty as they await the U.S. Supreme Court’s decision on whether or not to allow doctors and patients to sue California over Medi-Cal reductions.
If the Supreme Court rules in favor of California, the State could make payment rate reductions to health providers accepting CalOptima coverage. This would reduce funding for health services offered by the providers and cause patients covered under CalOptima to pay more out of pocket for services.
Garden Grove Pharmacist Thu-Hằng Trần was in Washington D.C., showing her support as a representative of plaintiffs in the case on 3 October 2011.
She told the Viễn Đông that she received an invitation to apply for a spot on the CalOptima board, yet turned it down.
“It’s best to stay outside,” she told the Viễn Đông, adding that she attends monthly meetings but feels she is more effective and able to speak up about controversy if she’s not on the board.
One such example of controversy, reported in June, was the CalOptima behind-closed-doors vote for $250,000 executive bonuses while CalOptima Medi-Cal patients were facing higher prescription costs.

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