CalOptima terminates contracts with 4 OC hospitals that serve low-income patients

Ashley Mackey Image
Tuesday, February 20, 2024 8:37PM
CalOptima terminates contracts with 4 Orange County hospitals
CalOptima, a health insurance agency that runs the Medi-Cal program in Orange County, has announced that it will be terminating contracts of four Prime Healthcare community hospitals in the county.

ORANGE COUNTY, Calif. (KABC) -- CalOptima, a health insurance agency that runs the Medi-Cal program in Orange County, has announced it will be terminating contracts of four Prime Healthcare community hospitals in the county.

Now, more than 300 CalOptima patients have signed an online petition, urging the company to reconsider its decision.

"It's a matter of life and death coming from my house to here," said Robin Wilson, a CalOptima patient and plaintiff in a lawsuit against them. "I don't want to have to drive 5 miles away, or a place that I know won't take good care of me."

The impacted hospitals are West Anaheim Medical Center, Garden Grove Hospital Medical Center, La Palma Intercommunity Hospital and Huntington Beach Hospital.

Attorney Lloyd Bookman's firm has filed a lawsuit against CalOptima on behalf of eight OC CalOptima members to try to stop the termination.

"Medi-Cal patients who are, by definition, lower-income folks, are going to have their community hospitals taken away from them, so that they may not be able to get access to those hospitals," he said. "That'll mean they'll have to go further for care."

Eyewitness News spoke with Yunkyung Kim, the chief operating officer of CalOptima Health, who says although the contracts with the hospitals are being terminated, members can still receive emergency services from the four hospitals.

She says while there are no changes to members benefits, patients will no longer be able to have scheduled visits or be admitted at the four hospitals.

"What we've seen is that the majority of our members who are using these four hospitals are really using the emergency room," Kim said. "There are a few members who are using it for scheduled services and so, again, this is also why we feel that we're not really impacting access to care. For those few members who are using it for scheduled services, again, we can work with them individually on coordinating a transfer."

Prime Healthcare hospitals spokesperson Fred Ortega said they share the patients' concerns. He says last year, from January to October, the four hospitals saw about 27,000 CalOptima members in the ER and about 25% of them needed to be admitted.

"They can say, 'Sure, they can show up at the ER and get treated' but they're leaving out if the fact that if they need to be admitted, our physicians won't be able to admit them into our hospitals," Ortega said. "If we're not in our network, they're going to send those patients to a different hospital."

Kim stresses that this does not effect their access to care.

"For those individual cases where patients are looking for, 'What does this mean for me? Where can I go for services?' We really encourage our members, please call us, and allow us to walk you through that, and work with you and your doctor on that."

CalOptima planned to terminate the contracts on Feb. 5.