In Marin County starting July 1, the old Medi-Cal or Medicaid health care program instituted in 1966 will be switched over by the County Organized Health Systems to a managed-care program for low-income seniors. This new program involves 16,000-plus people (approximately 1,000 children) under Healthy Families.
This new Medi-Cal managed-care program, sometimes referred to as “mangled care,” is being implemented by Marin County along with Mendocino and Ventura counties to over 150,000 low-income seniors and the handicapped to save money, under Partnership Health Plan of California (out of Fairfield).
As a consumer advocate and resident of Marin County for over 50 years, I understand the California budget crisis and the increased costs of health care, especially to seniors, disabled and the working poor, along with the unemployed, but something is drastically wrong with our county Board of Supervisors who have been sold this bill of goods under the county Organized Health System Plan.
This new program has been sold to the Board of Supervisors with the following goals and objectives:
This Partnership Health Plan of California (PHC) will improve access to care for all patients.
• The new program will reduce use of emergency rooms for routine care.
• It will improve the quality of care.
• It will run a locally responsive organization in Marin County.
• It will increase provider reimbursements
• It will increase scope of service to the members.
Well, Marin, I will tell you what this program really does and why it should not be implemented over the Fourth of July holiday weekend as it needs to be delayed at least 60-90 days:
• All brand-name prescriptions have to be switched to generics, which is an impossible task, according to Paul Lofholm, PharmD, Ross Valley Pharmacy, Larkspur, over a five-day holiday weekend, especially all 350 diabetes Medi-Cal patients who are on brand-name diabetes drugs being switched to a generic drug and insulin combination. This needs time for change and available physicians.
• All pain meds must be switched to Methadone.
• All diabetes brand names, such as Actose, must be switched to Metformin and insulins.
• Prior authorizations to obtain a brand name Rx from a generic are going to take 48 hours or two days to obtain.
• Physicians who are in the old network are being switched to new physicians in clinics; some of the clinics are a distance away from patients with no transportation.
• Zsuzsanna Biran, pharmacist-owner of West Marin Pharmacy in Pt. Reyes, says the fee on a take-it-or-leave-it basis is $1 plus the cost of the ingredient. The fee for pharmacists used to be $7.23 per prescription plus cost of the ingredients. Marin County has the largest percentage of seniors per capita of all California counties. Reimbursing the pharmacist $1 per prescription will not cover the cost of gasoline for deliveries to seniors with no transportation (the lame, physically challenged, blind). This new program will virtually eliminate free delivery services, as it is illegal to charge for delivery to this population.
• This entire program is being phased in for our 16,000-plus beneficiaries over a Fourth of July holiday weekend with no physicians available on Friday, July 1, or Monday, July 4, making it impossible for patients to get new drugs and see MDs to switch to the generics.
Managed-care program such as Kaiser Permanente’s can do a good job in coordination of care and reducing costs for chronically ill patients, but this new plan needs more than a holiday weekend to be phased into the system.
These patients and customers are not long-haired hippies. They are our seniors and our children, folks like your next-door neighbor who has lot his/her job and needs to depend on the Medi-Cal low-cost health care network to survive. A 60- to 90-day delay of this program will at least give patients time to get new physicians, coordinate their care, get the switching that needs to be done on the new Partnership for Health formulary and have public hearings to be sure availability, accessibility and quality of care are met.
I strongly suggest if we can’t achieve a delay in this program, caregivers and health care providers should call Medi-Cal patients to notify them about the new program and the switch in doctors and prescription medications as of July 1 and load up on their refills, especially patients with chronic care conditions, so they do not run out of their prescription drugs over the Fourth of July weekend.
By: Fred Mayer
Judd Matsunaga of Elder Law Services is a qualified attorney who has helped hundreds of California residents with Medi-Cal Planning. Mr. Matsunaga can be reached for a free consultation by calling 1-800 403-6078.