As San Benito County prepares to move Medi-Cal patients to a managed care program by Sept.1, the state Department of Health Care Services has contracted with a consultant to help with enrollment and education of patients.
San Benito County supervisors agreed June 18 to provide space for the consultants who will be sharing information with eligible residents on how their Medi-cal coverage has changed. Maximus, Inc. employees have been contracted with the state since 1997 to help enroll residents in health-care options, a state managed care program.
County staff members from Health and Human Services will continue to determine whether patients are eligible for Medi-Cal coverage, but Maximus, Inc. will help with getting those who are eligible enrolled in the Anthem Blue Cross plan. State officials selected Anthem Blue Cross to provide coverage in San Benito County, which already has many private companies that offer the insurance to residents. Maximus, Inc., employees will explain to Medi-Cal patients how to enroll and how they can seek medical services.
Maria Corona, the interim director for San Benito County’s Health and Human Services, said in other counties there are multiple healthcare options from which Medi-Cal patients can select. But due to its size, San Benito will only offer Anthem Blue Cross, the provider selected by the state. San Benito County is one of 20 counties in California expected to implement managed care by Sept. 1. San Benito County is one of a handful of rural counties that have been excluded from a statewide managed health system because the county is not contiguous to other participating counties.
In managed care, providers are encouraged to keep the cost of healthcare low. Some of the staples of managed care systems include incentives for patients and physicians to seek the lowest-cost appropriate treatment, an emphasis on preventative care and sometimes even requiring prior approval needed lab tests or referrals to specialists.
“We really have a need to start implementing it and sending out notices to let people know that this is coming,” Corona said.
She said the goal is to start screening residents for eligibility starting July 1 and working with Maximus staff members to get them enrolled before Sept. 1.
“They (state officials) told us it is a tough transition – it is not an easy transition,” Corona said. “We are hoping to have everything ready by the implementation date.”
The enrollment and outreach efforts will try to prevent patients from not selecting a healthcare plan, which can lead to an automatic default assignment in the state’s database. A default assignment can disrupt continuity of healthcare services, change patient and provider relationships, and can cause barriers to receiving healthcare.
Corona said she is planning a stakeholders meeting that will include local medical providers in the near future to discuss the change to a managed care program.
San Benito Coutny supervisors had originally sought a partnership with the Central California for Health, a nonprofit that provides managed care in Santa Cruz, Monterey and Merced counties. Supervisors went so far as to sign a letter of intent that went to state officials that they were ready to join the Alliance. But disagreements about providing care between two of the largest Medi-Cal provides in San Benito County – Hazel Hawkins Memorial Hospital and San Benito Health Foundation – caused Alliance board members to vote against including San Benito in the Alliance.
Rosa Vivian Fernandez, president and CEO of the San Benito Health Foundation, expressed concerns at the April 16 board of supervisors meeting that the alliance partnership would force her to refer patients to Hazel Hawkins Memorial Hospital rather than to Saint Louise Regional Hospital in Gilroy. Ken Underwood, the CEO of Hazel Hawkins Memorial Hospital, said he was concerned the alliance would allow the foundation to continue a referral pattern of sending patients out of the county for services that are available in Hollister.
Corona added that more changes will be coming to Medi-Cal coverage next year when more federal healthcare reform changes are implemented in California.
