The CalOptima Board of Directors approved staff’s recommendation to move forward with an application to serve as a Dual Eligibles Demonstration site, with the expectation that CalOptima and the County of Orange will agree to language concerning the County’s ongoing role in administering In-Home Supportive Services and Medi-Cal mental health services, and with the assurance that a definitive go/no-go decision can be made by the CalOptima Board once additional information about financial risks and program design is known.

Applications are due to DHCS on Feb. 24. If CalOptima is selected as a demonstration site, its OneCare program would likely transition into the demonstration project. The future of other (Kaiser Permanente and commercial) SNP programs operating in the county is unclear at this time. CalOptima would receive capitated rates for this population, and rates to hospitals are also unknown at this time. It would be expected that hospital volumes for this population would drop, as all efforts would be made to prevent hospitalization, reduce readmissions, and expand community and in-home care support. Stakeholder engagement is required on access issues.

Additionally, the Board received a status report from staff on the CalOptima/UCI Intergovernmental Transfer Agreement. Board members again expressed interest in understanding options for use of the funds coming back to CalOptima. Staff will provide the Board with additional information in the coming weeks, and an action item will be scheduled for the March 1 Board Meeting.