“I think we’re feeling more comfortable,” Zimmerman said. He said the agency was told Gold Coast will cover all those issues. “Patient care will not be disrupted at all,” she said.īarry Zimmerman, director of the Ventura County Health Care Agency, said the news of the closure sparked initial concerns about care for the HMO’s Medi-Cal patients and possible barriers for treatment authorizations and payments for care. Clinicas will continue to provide treatment for all of the patients, she said. Medicare Advantage plans that had assigned patients to AmericasHealth Plan will also take over the coverage over the next several months, Pawar said. Local health systems to pay more than $70 million in settlement over Medi-Cal claims “Our top priority is to prevent any interruptions to their care.” “We will be working closely with the leaders from Clinicas del Camino Real to ensure a seamless transition for these members and the providers who care for them,” said Nick Liguori, Gold Coast’s CEO. Patients being treated in the Clinicas system will stay there and will be able to keep their current doctors or pick new ones. Coverage that had been handled by the HMO will transition back to Gold Coast. Gold Coast officials declined interview requests but issued a news release Thursday stating its partnership with AmericasHealth Plan ended Friday because of the planned closure. The balance of the HMO's enrollees came from similar “plan to plan” contracts with Medicare Advantage insurers including SCAN, Anthem Blue Cross and Central Health Medicare Plan. In the partnership, started in 2021, as many as 10,000 Medi-Cal members were given the choice of having their coverage handled by AmericasHealth Plan. Triggered by financial lossesĪmericasHealth Plan, a for-profit company created by Clinicas in 2011, covers about 9,000 low-income people in a pilot program with Gold Coast Plan, the public entity that administers Medi-Cal insurance to more than 250,000 people in Ventura County. It will stay open perhaps until the end of the year in an "unwinding" process designed to protect continuity of care, she said.ĭurawa said in a statement he could not comment on any other aspect of the investigation. The layoffs and pending closure has stoked false speculation the plan is shuttering immediately, Pawar said. She said Clinicas has not been told of the investigation. Pawar said both the Department of Managed Health Care and the California Department of Health Care Services, which oversees Medi-Cal plans, were notified of the changes by a consulting company now running the HMO's daily operations. The notice is required directly from insurance plans going through a closure or change of control. The probe focuses partly on the lack of notification documents filed by AmericasHealth Plan, he said. The California Department of Managed Health Care, which regulates insurance plans, learned of AmericasHealth Plan’s pending closure on Monday and immediately opened an investigation, said spokesman Kevin Durawa. "We are refocusing ourselves on what we are good at," she said. She said the move is part of a plan to focus on caring for low-income people and other under-served populations. The decision to close the HMO was fueled by AmericasHealth Plan’s continued losses as well as spiraling costs felt by Clinicas and health care systems nationwide, said Clinicas CEO Dr.
It operates on a budget of more than $100 million, including about $14 million in federal money. Headquartered in Camarillo, Clinicas reported a $15 million loss last year, laid off 12 of 13 employees at its subsidiary HMO, AmericasHealth Plan, in mid-March and began a closure process that could take nine months.Ĭlinicas is a nonprofit system that started as a clinic for farmworkers in the 1970s and now consists of 16 clinics across Ventura County. State regulators said they weren’t properly notified of the move and have opened an investigation. Financial pressures that tightened during the pandemic are pushing Clinicas del Camino Real health system to close over several months an insurance plan covering about 12,000 people on Medi-Cal and Medicare, company officials said.
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