By Tom Kisken, THE VENTURA COUNTY STAR
March 22, 2019
The tax documents showed up on a reporter’s desk multiple times, all sent anonymously. One of the senders marked gaudy compensation levels with a highlighter, scrawling a note in a margin.
“Is Clinicas really out to serve the underserved of our county or are they just out to serve themselves?”
The documents showing Roberto Juarez’s reported compensation neared $4 million in fiscal year 2016 are salvos in the ongoing war over Medi-Cal in Ventura County. Juarez and his employer said the lion’s share of the compensation represents a rapidly built retirement fund put off for years because of financial limitations.
Juarez, CEO of a nonprofit Clinicas del Camino Real system created to serve farmworkers and others, wants to redo Ventura County’s current health care system to the region’s poorest residents. The drive would eliminate the publicly funded Gold Coast Health Plan that administers Medi-Cal health insurance for the nearly 200,000 affected residents.
In the so-called two-plan system advocated by Juarez, Medi-Cal members would choose between competing insurers, including a private plan that would be picked by the state after a bidding process. AmericasHealth Plan, a for-profit HMO created by Clinicas, would likely compete to be the commercial plan but might also attempt to partner with another insurer.
Supporters of the change, including a coalition of Latino leaders, are pushing for state legislation mandating the move, although a comprehensive bill has not been introduced. They also want to take the issue to Ventura County voters in a ballot initiative in March 2020.
The fight could surface again Monday. The commission that governs Gold Coast is set to discuss a proposed pilot partnership in which a for-profit HMO created by Clinicas would act as the insurer for 5,000 patients, taking on the financial risk and rewards.
Delays in implementing variations of the long-pledged partnership are contributing reasons why Juarez wants to replace Gold Coast. He alleges the plan has treated his clinics unfairly for nearly a decade, also alleging racial bias. Juarez and others contend providing more choices will improve access and quality of care.
Gold Coast leaders say the accusations of unfair treatment and racism are patently untrue. They contend the current system already provides choices in terms of doctors, hospitals and clinics and serves all members with no gaps. Other Gold Coast supporters contend the two-plan model could disrupt care and cause confusion among patients, doctors and others.
In an interview Wednesday, Gold Coast CEO Dale Villani argued that Clinicas’ 990 tax filings offer insight on why Juarez and others want the change.
“For me, this is trying to get a bigger piece of the pie,” he said.
In the fiscal year ending June 30, 2017, Juarez was paid a base salary of $437,257, according to the tax document. It shows $641,179 in bonuses and incentives, pushing total compensation to $1.1 million, although Juarez contends the extra payment reflects refunds for a series of earlier tax miscalculations.
The numbers are higher in the two previous years. Juarez’s compensation in fiscal year 2016 totaled $3.9 million, boosted by $3.5 million in reported compensation outside of salary and incentives.
He totaled $3.7 million in compensation the previous year, with nearly $3.3 million of it listed as other compensation.
Clinicas leaders say the numbers are misleading and reflect the meager beginnings of a clinic system that started as a Santa Paula free clinic housed in what was once a motel. A bedsheet was used as a partition to separate exam rooms.
The system couldn’t afford to invest in adequate retirement, said Charles Hookstra, the former Oxnard assistant police chief who now heads Clinicas’ board.
Juarez joined on as executive director in 1978 when the nonprofit’s annual budget was $90,000. He grew Clinicas into a countywide system that includes 14 clinics, mobile units and more than two dozen school-based health sites.
It now employs 800 people and operates on a budget of $100-plus million a year. Several years ago, the board voted to aggressively build a retirement fund for the now 70-year-old Juarez of about $4 million. The plan was designed to generate $160,000 a year or more in retirement, Hookstra said.
Although the plus $3 million figure is listed in two separate years on the 990s, it will be paid out just once, Hookstra said.
Other retirement fund-building efforts have been launched for Clinicas Chief Financial Officer Christina Velasco and Chief Business Development Officer Tony Alatorre.
Velasco’s total compensation was $1.2 million in fiscal year 2017 with about $900,000 of it listed as “other compensation” and aimed at retirement. Alatorre’s total compensation was $727,642, with more than $440,000 coming in “other compensation.”
“We as a board tried to play catch up,” said Hookstra.
The tax returns triggered reactions in and outside Ventura County.
“Shock and awe,” said Carmen Balber, of Consumer Watchdog in Santa Monica, citing Clinicas’ role as a safety net for people who might otherwise not receive care. “Any time you see multi-million compensation packages, they raise serious concerns, especially at a nonprofit that is supposed to providing care for the lowest-income Californians.”
Ventura County Supervisor Steve Bennett reacted to the 990s by pointing to the proposal to replace the current Medi-Cal system with a two-plan model that could include the HMO created by Clinicas.
“The money should be going to services for low-income people, not million-dollar salaries for top executives ... and this for-profit plan could make that problem even worse,” said Bennett, who opposes the two-plan proposal.
Others contend Juarez’s priorities have always been patients and the care his clinics provide.
“This man has been devoted, determined and dedicated toward one thing — access to quality care,” said David Cruz, radio broadcaster and friend. “I see him as a laser-focused, move-ahead kind of guy.”
Juarez said the retirement investments came from reserves and were not taken from Clinicas’ government funding or money earmarked for patient care.
He compares the payout to other retirement funds, arguing that a government pension plan built over 40 years can exceed what he will receive.
He acknowledges being paid well. He owns two BMWs and an Escalade SUV and lives in a Camarillo home bought for $848,000. He suggested his financial success has become more of a target because he’s Latino.
“People can’t see minorities getting anything,” he said.
Juarez grew up in Oxnard. He’s a Vietnam veteran and an activist who marched with civil rights leader Cesar Chavez.
He worked for several years as a government employee and was a Ventura County hospital administrator in the late 1970s when Diana Bonta, then a young nurse working for the state of California, helped recruit him to lead the free clinic that grew into Clinicas.
“He was brash. He was energetic, talkative but also willing to learn,” said Bonta, who later became director of the California Department of Health Services. “He wasn’t afraid of taking risks.”
He also isn’t afraid of controversy. He accused the county system of diverting patients from his system to county-run clinics in allegations the county denied. Five years ago, Clinicas filed a lawsuit alleging Gold Coast assigned Clinicas patients to other clinics in litigation that drew a cash settlement Juarez describes as a victory.
Mike Powers, Ventura County executive officer and once the director of the county’s Health Care Agency, has known Juarez for nearly 20 years.
“I respect Roberto’s mission for the underserved,” he said. “I’ve always respected that. I think we share that.”
The county and Clinicas have partnered on many projects, including a past program aimed at providing health care for the uninsured. Clinicas and AmericasHealth Plan contract with the county to use its large network of specialists also using their own network, according to Juarez.
“We’ve partnered, and we’ve had times when we’ve disagreed,” Powers said, noting that in the conflicts, the accusations flow one way, from Clinicas toward the county. “That’s pretty much been it.”
Others contend Juarez’s public actions are dictated by the needs of the health system he built.
“I think it’s all about his advocacy for the system,” said Dr. Lanyard Dial, who has known Juarez for several years and served with him during Juarez’s term on the Ventura County Medi-Cal Managed Care Commission. “He’s tried to point fingers at Gold Coast when he’s felt his system has not been fairly treated.”
Juarez said perceptions of him always being on attack are untrue.
“When people start throwing rocks at my window, absolutely I’m going to be there,” he said, noting he often restrains himself in discussions involving Gold Coast. “If I got up every time they bad-mouthed me or Clinicas, I would be doing that 24-7.”
As others question his motives in the drive to change Medi-Cal, Juarez said the goal is self-determination. He doesn’t want to be dependent on Gold Coast, the Ventura County Health Care Agency or anyone else. He wants his patients’ care to be provided by his clinics and coordinated by AmericasHealth Plan.
His frustration comes partly from repeated delays of a long-planned partnership in which AmericasHealth Plan would act as insurer for people cared for in the Clinicas system. On Monday, commissioners could vote on a pilot project involving AmericasHealth Plan.
Ventura County Supervisor John Zaragoza is set to join the commission on Monday, succeeding Supervisor Bob Huber. Zaragoza said his interest in the commission revolves around the more than 80,000 Medi-Cal members in the Oxnard area.
He said he supports the pilot partnership with AmericasHealth Plan but opposes the proposal to eliminate Gold Coast and replace it with a two-plan system.
He has known Juarez for more than 20 years. His brother is married to Juarez’s sister.
“I’m not taking sides,” said Zaragoza, rejecting any suggestion of a conflict and calling himself neutral. “I’m taking sides on behalf of the constituency.”
Juarez said he doesn’t see Zaragoza as an ally, although he thinks the supervisor was added to the commission to appease him.
“He’s trying to push this 5,000 lives,” he said of the proposed pilot project on Monday’s agenda. “He is pushing that so hard. I’m not interested in that.”
Juarez said that instead of a pilot project, he wants AmericasHealth Plan to act as the insurer for all of its 38,000 Medi-Cal patients.
“That’s what it’s all about — Gold Coast doing what they said they’re going to do,” he said.