Report 2022-502 Recommendation 6 Responses

Report 2022-502: Follow-Up: Children in Medi‑Cal: The Department of Health Care Services Is Still Not Doing Enough to Ensure That Children in Medi‑Cal Receive Preventive Health Services (Release Date: September 2022)

Recommendation #6 To: Health Care Services, Department of

To ensure that eligible children and their families know about all the preventive services they are entitled to through Medi-Cal, DHCS should include clearer and more comprehensive information about those services in its written materials and ensure annual follow-up with any children and their families who have not used those services.

Annual Follow-Up Agency Response From December 2023

DHCS has made updates to the outreach materials to be in alignment with the Strategy to Support Health and Opportunity for Children and Families. Outreach materials include consumer-friendly brochures explaining the preventive services as well as other services available to all children under Early and Periodic Screening, Diagnostic, & Treatment (EPSDT), and a "Medi-Cal for Kids & Teens: Your Medi-Cal Rights" document which will assist enrolled members in understanding rights to services and the steps to secure services if challenges occur. DHCS took necessary steps to conduct focus testing with both enrolled members and key stakeholders on the member facing materials. Member and stakeholder testing concluded in Q1 of 2023. DHCS released the updated materials on February 14, 2023, to the MCPs and posted the materials on DHCS' public website (https://www.dhcs.ca.gov/services/Medi-Cal-For-Kids-and-Teens/Pages/home.aspx). DHCS directed the MCPs, via All Plan Letter 23-005 on March 16, 2023, to send member-facing materials to members under the age of 21, including any family members, beginning in June 2023 and annually thereafter. In addition, DHCS released provider training materials on February 14, 2023, to the MCPs to ensure providers understand the services covered for children under EPSDT and MCPs' responsibilities to ensure appropriate care. Additionally, DHCS mailed outreach materials directly to members in the Fee-For-Service Program in English and Spanish on August 28, 2023, and all other languages on August 25, 2023 (see Attachment 11 in the Substantiation folder).

California State Auditor's Assessment of Annual Follow-Up Status: Fully Implemented

DHCS completed updates to its outreach materials and requires Managed Care Health Plans to annually inform children and their families of the preventive services to which they are entitled through Medi-Cal.

1-Year Agency Response

DHCS updated the outreach materials to be in alignment with the Strategy to Support Health and Opportunity for Children and Families. Outreach materials and conducted focus testing with both enrolled members and key stakeholders on the member-facing materials by Q1 of 2023. DHCS released the updated materials on February 14, 2023 to the Managed Care Providers (MCP) and posted the materials on DHCS' public website (https://www.dhcs.ca.gov/services/Medi-Cal-For-Kids-and-Teens/Pages/home.aspx). DHCS directed the MCPs, via All Plan Letter 23-005 on March 16, 2023, to send member-facing materials to members under the age of 21, including any family members, beginning in June 2023 and annually thereafter. In addition, DHCS released provider training materials on February 14, 2023 to the MCPs to ensure providers understand the services covered for children under Early and Periodic Screening, Diagnostic and Treatment (EPSDT) and MCPs' responsibilities to ensure appropriate care. Additionally, DHCS mailed outreach materials directly to members in the Fee-For-Service Program in August 2023.

California State Auditor's Assessment of 1-Year Status: Partially Implemented

DHCS did not provide evidence to substantiate that it had fully implemented this recommendation.

6-Month Agency Response

DHCS has made updates to the outreach materials to be in alignment with the Strategy to Support Health and Opportunity for Children and Families. Outreach materials include consumer-friendly brochures explaining the preventive services as well as other services available to all children under EPSDT, and a "Medi-Cal for Kids & Teens: Your Medi-Cal Rights" document which will assist enrolled beneficiaries in understanding rights to services and the steps to secure services if challenges occur. DHCS took necessary steps to conduct focus testing with both enrolled beneficiaries and key stakeholders on the beneficiary facing materials. Beneficiary and stakeholder testing concluded in Q1 2023. DHCS released the updated materials on February 14, 2023 to the MCPs and public website.

DHCS directed the MCPs, via All Plan Letter 23-005 on March 16, 2023, to send member-facing materials to beneficiaries under the age of 21, including any family members, in Q2 2023 and annually thereafter. In addition, DHCS released provider training materials on February 14, 2023 to the MCPs to ensure providers understand the services covered for children under EPSDT and MCPs' responsibilities to ensure appropriate care. DHCS will send outreach materials directly to beneficiaries in the Fee-For-Service Program. The mailing is scheduled for Q2 of 2023.

California State Auditor's Assessment of 6-Month Status: Pending

Per DHCS's response, it will not implement this recommendation until June 2023.

60-Day Agency Response

DHCS has made updates to the outreach materials to be in alignment with the Strategy to Support Health and Opportunity for Children and Families. Outreach materials include consumer-friendly brochures explaining the preventive services as well as other services available to all children under EPSDT, and a "Know Your Rights" document that will assist enrolled beneficiaries in understanding their rights to services and the steps they should to secure services if they encounter challenges. DHCS is currently taking necessary steps to conduct focus testing with both enrolled beneficiaries and key stakeholders on the beneficiary facing materials, as well as a renaming of the term, "EPSDT," to more appropriately resonate with beneficiaries, families, and providers. Beneficiary and stakeholder testing is targeted to begin in Q4 2022. DHCS is still targeting to release the updated materials by the end of Quarter 1 (Q1) 2023 to the MCP. Upon implementation, DHCS will direct the plans, via an All Plan Letter, to send member-facing materials to beneficiaries under the age of 21, including any family members, in Q1 2023 and annually thereafter. In addition, DHCS is developing provider training materials that MCPs will use to ensure providers understand the services covered for children under EPSDT and MCPs' responsibilities to ensure appropriate care. DHCS will send outreach materials directly to beneficiaries in the Fee-For-Service Program. The mailing is scheduled for Q1 of 2023.

California State Auditor's Assessment of 60-Day Status: Pending

Per DHCS's response, it will not implement this recommendation until March 2023.

All Recommendations in 2022-502

Agency responses received are posted verbatim.