Ken Carlson

Red ink prompted state monitoring of Health Plan of San Joaquin

Dr. Pankaj Patel, administrator David Thompson and their Turlock attorney, Mike Warda, spoke Wednesday to the 11-member commission that governs Health Plan of San Joaquin. They advocated for dental surgery centers and the low-income children who receive badly needed treatment at the centers.

According to Patel, three of 1,000 requests to perform anesthesia dentistry at Salida Surgery Center have been approved by the Medi-Cal managed-care plan since September. Patel’s center in Salida, and the two managed by Thompson in Stockton and Atwater, are often a last resort for children who are too young or have too much dental decay to be treated by regular dentists.

A state law requires Medi-Cal managed-care plans, such as Health Plan of San Joaquin, to reimburse dental surgery centers for anesthesia and pay a facility charge. San Joaquin County’s locally grown health plan formerly paid for the services, but for the past five months has required extensive proof on the need for anesthesia, effectively denying care for the children and severely disabled adults.

Speaking during the public comment period, Patel and Thompson asked to be placed on a future agenda. The commission, headed by Greg Diederich, had no comment, and it’s not clear if the panel will formally discuss the issue.

With thousands of people flocking to the Medi-Cal program through federal health reform, readers may need to know about Health Plan of San Joaquin. That county founded the plan as a public entity in 1996 during the state’s effort to establish the managed-care model for Medi-Cal, the health program for the poor and uninsured.

The local plan and others like it reduce costs for the state and federal governments by restricting the care for Medi-Cal patients to a network of physicians, hospitals and care centers.

The plan says it has nearly 300,000 members in San Joaquin and Stanislaus counties today. It began serving Stanislaus residents in January 2013 under a contract with the county Health Services Agency. Stanislaus residents in the Medi-Cal program can choose Health Plan of San Joaquin or Health Net Community Solutions.

Health Plan of San Joaquin has dealt with recent financial challenges, according to staff comments at Wednesday’s meeting. It recorded a $14 million loss in the previous fiscal year and state officials have monitored the plan because its financial reserves were below standard. The plan has bounced back in the current year, ending December with a $20 million net margin, and will ask to be removed from the state’s watch list, said Chief Executive Officer Amy Shin.

The health plan suffered losses in Stanislaus County a year ago when member utilization was higher than projected. The state granted higher rates for Stanislaus, more than correcting the deficit, but the plan expects to start seeing losses in San Joaquin County, Shin said. The state gives the plan a primary rate per member each month and expects it to manage health care costs within that amount.

Mary Ann Lee, director of Stanislaus County’s Health Services Agency, said she knew Health Plan of San Joaquin was on the state’s watch list but is satisfied the agency is making progress. “They are doing a lot of things right,” Lee said. “Their membership has been growing. They have the larger membership between themselves and Health Net.”

The Affordable Care Act and the dramatic expansion of Medi-Cal rolls are forcing Health Plan of San Joaquin to increase its workforce or get buried under the workload. It has no more cubicle space in its building on South Manthey Road near San Joaquin General Hospital in French Camp, so the preferred option is leasing more space in the complex housing its Modesto office at 1012 10th St.

The office would expand from 3,600 to 11,000 square feet, increasing the annual lease from $58,530 to $137,780. The plan could add 55 to 75 employees to the Modesto office, a spokesman said.

In another development, a group of health plan employees is moving toward union membership for the first time in the agency’s 18-year history. Some are upset about cuts to benefits and retirement, an employee said.

The next meeting of the Health Commission over Health Plan of San Joaquin is Feb. 25, mostly likely at 5 p.m. in the community room at 7751 S. Manthey Road in French Camp.

Bee staff writer Ken Carlson can be reached at kcarlson@modbee.com or (209) 578-2321.

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