Medi-Cal dispute leaves thousands looking for doctors in three Valley counties

CalViva Health has terminated a contract with Kaiser Permanente, leaving about 9,000 people on Medi-Cal in Fresno, Kings and Madera counties to find new doctors beginning Sept. 1.

Note: The original version of this story incorrectly reported that Tulare County was affected, and omitted Madera County.

Both Kaiser and CalViva, the locally governed Medi-Cal managed care plan for the three counties, said they negotiated in good faith, but were unable to come to an agreement.

“As you can imagine in today’s health-care environment, contract negotiations are very complex and there are many factors that must be considered,” said CalViva Executive Director Gregory Hund.

Hund said CalViva submitted several proposals to Kaiser that were rejected. Kaiser was asked to provide a counter proposal, but CalViva never received one, he said.

Kaiser said it regrets CalViva’s decision to terminate the contract. “We made good-faith efforts to come to an agreement that would prevent our patients from losing their access to Kaiser Permanente physicians and services,” said Debbie Hemker, senior vice president and area manager for Kaiser-Fresno.

Hemker left open the possibility of Kaiser somehow participating in the Medi-Cal market. “We are exploring future options that would enable Kaiser Permanente to again directly serve Medi-Cal recipients in the community,” she said.

The Calviva/Kaiser contract split affects about 2.5 percent of CalViva’s total membership, and leaves the 9,000 Kaiser patients with two plan choices: CalViva Health – administered by Health Net – and Anthem Blue Cross.

The departure of Kaiser from the Medi-Cal market in the three counties means more Medi-Cal patients seeking care from the small pool of doctors willing to accept them.

Hund said CalViva has 300 primary-care doctors and 1,100 specialists and 10 hospitals, enough to adequately service the Kaiser members.

“Prior to the end of the contract, we created a transition plan to ensure that all members continued to have access to excellent care,” he said. “As part of that plan, our staff visited every primary care physician’s office to let them know about the change and to ensure members were accommodated as quickly as possible,” he said.

Kaiser said it now is focused on helping patients transition to new doctors. About 900 patients will continue to receive care from Kaiser after Sept. 1 to allow for ongoing treatment of a specific condition, Hemker said.

Diana Parret, a Kaiser patient in Fresno, said she has begun the process of finding a new primary care doctor and so far the experience has not been good. She called a doctor on a CalViva-provided list and was told the physician should not have been included as a Medi-Cal provider.

Kaiser has been Parret’s insurance since 2014. At that time, she had lost a job and the employer-sponsored insurance that came with it, and signed up for a Kaiser health plan through Covered California, the state’s health insurance exchange created for the Affordable Care Act. In July, she became eligible for Medi-Cal. And she chose Kaiser as her Medi-Cal provider.

Parret said Kaiser doctors found an aggressive uterine tumor in time to save her life three years ago. The Sept. 1 termination of the CalViva contract has her worried. “It really puts me in a precarious situation.”

This story was originally published August 26, 2017 at 7:00 AM with the headline "Medi-Cal dispute leaves thousands looking for doctors in three Valley counties."