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California State Auditor Report Number : 2014-134

California Department of Health Care Services
Improved Monitoring of Medi-Cal Managed Care Health Plans Is Necessary to Better Ensure Access to Care

Figure 1

Figure 1 is a line-graph illustrating the number of actual and projected additional beneficiaries enrolled in the California Medical Assistance Program because of the Patient Protection and Affordability Care Act from January 2014 through 2019. At the implementation in January 2014 there were nearly 24,000 additional beneficiaries enrolled in the program. Over the next nine months there was a sharp increase in additional beneficiaries, with the total number of additional beneficiaries enrolled into the program reaching 1.16 million by September 2014. The projections going forward indicate a modest increase in additional beneficiaries over the next five years, with the total additional beneficiaries in the program expected to reach 1.34 million by 2019.

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Figure 2

Figure 2 is a color-coded map of California with each county labeled and color-coded to match the corresponding Medical Assistance Program Managed Care model. The six models are as follows: County-Organized Health Systems, Regional, Two-Plan, Geographic Managed Care, Imperial, and San Benito.

The following 22 counties use the County-Organized Health Systems model: Del Norte, Humboldt, Lake, Lassen, Marin, Mendocino, Merced, Modoc, Monterey, Napa, Orange, San Luis Obispo, San Mateo, Santa Barbara, Santa Cruz, Shasta, Siskiyou, Solano, Sonoma, Trinity, Ventura, and Yolo.

The following 18 counties use the Regional model: Alpine, Amador, Butte, Calaveras, Colusa, El Dorado, Glenn, Inyo, Mariposa, Mono, Nevada, Placer, Plumas, Sierra, Sutter, Tehama, Tuolumne, and Yuba.

The following 14 counties use the Two-Plan model: Alameda, Contra Costa, Fresno, Kern, Kings, Los Angeles, Madera, Riverside, San Bernardino, San Francisco, San Joaquin, Santa Clara, Stanislaus, and Tulare.

Sacramento and San Diego counties each use the Geographic Managed Care model.

Imperial County uses the Imperial model, and San Benito County uses the San Benito model.

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Figure 3

Figure 3 is a bar-graph illustrating the number of contacts received monthly by the California Department of Health Care Services (Health Care Services) from January 2013 through January 2015. The number of contacts received each month is broken into three categories: Total cases handled, Contacts not answered, and Busy signals due to system limitations (busy signals). In addition to telephone calls, contacts and cases after July 2014 include email contacts that the ombudsman office received. The ombudsman office estimates that 5 percent of contacts came from these emails.

The total number of cases handled by Health Care Services was fairly consistent in 2013 ranging from a low of nearly 4,300 in June to a high of nearly 6,100 in December. The total number of cases handled increased from January 2014 through January 2015 ranging from a low of nearly 7,400 in March 2014 to a high or nearly 16,850 in October 2014.

In 2013, the number of contacts not answered ranged from a low of just over 7,500 in February to a high of nearly 10,100 in April. The number of contacts not answered from January 2014 to January 2015 also increased and ranged from just over 9,200 in April 2014 to 20,100 in January 2015.

The monthly number of busy signals varied the most out of the three categories. The monthly total busy signals ranged from a low of just under 7,400 in May 2014 to a high of more than 45,100 in March 2014. According to the phone service provider for Health Care Services, the phone service could not provide information on busy signals before February 2014.

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