Report 2020-613 Recommendations
When an audit is completed and a report is issued, auditees must provide the State Auditor with information and periodic reports regarding their progress in implementing the report’s recommendations. For audits conducted under the State High Risk Audit Program, these periodic reports are due every 90 days from the issue date of the report until such time as the State Auditor directs the auditee otherwise, according to title 2, section 61024 of the California Code of Regulations. Additionally, Senate Bill 1452 (Chapter 452, Statutes of 2006), requires auditees who have not implemented recommendations after one year, to report to us and to the Legislature why they have not implemented them or to state when they intend to implement them. Below, is a listing of each recommendation the State Auditor made in the report referenced and a link to the most recent response from the auditee addressing their progress in implementing the recommendation and the State Auditor's assessment of auditee's response based on our review of the supporting documentation.
Recommendations in Report 2020-613: Department of Health Care Services: Despite the COVID-19 Public Health Emergency, the Department Can Do More to Address Chronic Medi‑Cal Eligibility Problems (Release Date: July 2021)
| Recommendations to Health Care Services, Department of | ||
|---|---|---|
| Number | Recommendation | Status |
| 1 | To reduce inappropriate payments made to medical providers and ensure eligible individuals' access to care, Health Care Services should, by August 2021, begin monitoring statewide alerts related to individuals identified as eligible for Medi-Cal in a county eligibility data system but not identified as eligible in the state eligibility system. |
Pending |
| 2 | To reduce inappropriate payments made to medical providers and ensure eligible individuals' access to care, Health Care Services should, by August 2021, instruct counties to resume processing overdue determinations for individuals who have received temporary eligibility and make a determination on each applicant's Medi-Cal eligibility. |
Fully Implemented |
| 3 | To reduce inappropriate payments made to medical providers and ensure eligible individuals' access to care, Health Care Services should, by August 2021, expand its workgroup planning efforts to address all high-risk eligibility alerts included in the pilot program. |
Pending |
| 4 | To reduce inappropriate payments made to medical providers and ensure eligible individuals' access to care, Health Care Services should, by August 2021, resume monitoring pilot program counties' progress in resolving high-risk eligibility alerts. |
Pending |
| 5 | To ensure that it is addressing weaknesses in the counties' processes for making eligibility redeterminations, Health Care Services should review data collected during the focus reviews it conducted in 2018 and 2019 to identify areas in policy for which further county guidance is needed and, by September 1, 2021, share a written summary of the identified concerns with all counties. |
Fully Implemented |
| 6 | To ensure that it is addressing weaknesses in the counties' processes for making eligibility redeterminations, Health Care Services should resume county monitoring via focus reviews within four months of the end of the public health emergency. |
Pending |