New Valley Medi-Cal plan awaits state approval [The Fresno Bee, Calif.]

Sept. 20--CalViva Health, a new Medi-Cal managed care health plan in Fresno, Kings and Madera counties, had hoped to begin serving consumers next month, but consumers will have to wait a few more months until the state gives its approval.

On Thursday, CalViva executives met in downtown Fresno for what they had planned as a celebration to announce the launch of CalViva Health on Oct. 1. But state officials said later that day that the plan would not begin until Feb. 1.

The Department of Health Care Services still is negotiating reimbursement rates with CalViva, said spokesman Anthony Cava.

And CalViva, established in April 2009 by the Fresno-Kings-Madera Regional Health Authority, needs licenses from the California Department of Health Care Services and the state's Department of Managed Health Care before it can offer services to Medi-Cal consumers, Cava said.

The state approval process for CalViva has been "complicated by the state budget," said Greg Hund, the CalViva chief executive officer. State furloughs have meant the staffs have fewer days to review and process applications, he said.

When CalViva begins operations, it will be the first time health care for about 240,000 Medi-Cal patients in the three counties will be coordinated by two managed-care health plans.

Medi-Cal consumers will have a choice between CalViva, a locally governed and locally controlled health plan, and a commercial health plan offered by Anthem Blue Cross. Medi-Cal is the state-federal health insurance program for the poor.

Unlike commercial plans, CalViva will be under the direction of authority commissioners from the three counties. The authority will contract with doctors, hospitals and other health-care providers, and commissioners will address grievances of patients and providers.

But until the February start-up for CalViva, Medi-Cal consumers in Kings and Madera counties will continue on a fee-for-service Medi-Cal plan. Fresno County consumers currently enrolled in Health Net and Anthem Blue Cross commercial plans will remain with those plans for the time being.

"The important thing to point out is nothing will change for those Medi-Cal members currently enrolled in a plan," Cava wrote in an e-mail.

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