SAN FRANCISCO (AP) — Counties across California are increasingly asking to opt out of the state’s centralized vaccination program run by Blue Shield, further complicating Gov. Gavin Newsom’s plan to smooth out what has been a confusing and disjointed rollout of coronavirus vaccines.

None of the state’s 58 counties has signed a contract with the insurance giant even as the state moved ahead with plans to bring 10 counties in the inland sections of central and Southern California under Blue Shield oversight beginning this week, the Los Angeles Times reported Saturday.

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“The hesitations and uncertainties span urban, suburban and rural parts of the state,” said Sarah Dukett, legislative advocate for the Rural County Representatives of California. “It’s not always the case that everyone is in the same boat. I hope the state is listening to that, but they really seem to be full steam ahead.”

The state is in the process of switching over to a vaccine appointment and delivery system administered by Blue Shield that is expected to be completed by March 31. The decision announced in February to outsource functions to Blue Shield that had previously been managed by public officials at the state and local levels was intended to ensure vaccines are distributed equitably and reach low-income communities disproportionately affected by the pandemic.

Last week, San Joaquin County Board of Supervisors requested looking into opting out of what they called a “tremendous bureaucratic system” that would be implemented under Blue Shield.

In a March 2 letter to Newsom, leaders of the Los Angeles County Board of Supervisors asked to exempted from Blue Shield’s oversight, saying the insurer’s officials “have not demonstrated they have adequate understanding of the unique needs and features of Los Angeles County, its diverse population, and where our residents go for health care.”

Ventura County made a similar request, but state and Blue Shield officials said opting out was not allowed, said Barry Zimmerman, chief deputy director for the county’s Health Care Agency.

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Blue Shield officials told the state’s Community Vaccine Advisory Committee on Friday that contracts with counties were being finalized, although no timeline was provided. It’s unclear how a potential impasse with counties would affect vaccine distribution in those areas.

One of the counties’ main concern is a requirement in the Blue Shield contract that all vaccine providers use the state’s vaccine sign-up system, called My Turn. County officials have complained that the the system is riddled with flaws, some of which prevented counties from reserving appointments for targeted populations.

My Turn also requires vaccine providers to enter data twice: once in their own systems for billing and record-keeping, and a second time into the state’s new system. State officials said an interface between the two systems is scheduled to be completed in two weeks.

California announced Friday that it had surpassed 10 million vaccinations, with 1.67 million doses administered in the last seven days. It’s too early to attribute that uptick to changes under Blue Shield, a spokesperson for the California Department of Public Health said.

Counties are continuing to receive vaccine, despite the contract hang-ups. Erika Conner, a spokeswoman for Blue Shield, said vaccine providers who were already receiving doses before the new contract are continuing to receive them during the transition period.

“Our aim is to enhance the state network to support the state’s goal to increase its capacity and be able to administer 4 million doses a week — and we are well on our way to meeting that milestone,” Conner said in a statement.

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