Report 2022-502 Recommendation 8 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 #8 To: Health Care Services, Department of

To increase access to preventive health services for children in areas where they are needed most, DHCS should identify where more providers who see children are needed and propose to the Legislature funding increases to recruit more providers in these areas.

1-Year Agency Response

DHCS continues to disagree with the recommendation. DHCS does agree the number of physicians practicing in California would be beneficial for all health care delivery systems. As such DHCS has enacted the CalHealthCares program to increase access to preventive health services for children in areas where they are needed most. Further, in the 2022-2023 state budget, DHCS proposed additional allocation of funding for the program when minimum Medical Loss Ratio is not met by MCPs. The program has focused on supporting providers in under resourced communities.

DHCS anticipates 99 percent of beneficiaries will be enrolled in Medi-Cal MCPs by 2024. DHCS is committed to ensuring MCP networks are sufficient to ensure timely access to care for Medi-Cal members. DHCS has a robust process for reviewing networks, certifying adequacy, and refining processes to improve monitoring of networks and timely access to care. Current monitoring activities include surveying providers to assess compliance with appointment wait time standards; monitoring access to care grievances; and network certifications of MCPs. DHCS continually evaluates the processes to improve our ability to monitor and oversee MCP compliance with network adequacy requirements.

California State Auditor's Assessment of 1-Year Status: Will Not Implement

Although DHCS asserts that it has taken some steps to ensure that health plans provide timely access to care, without a targeted effort by DHCS to increase the number of Medi-Cal providers in underserved areas, children in Medi-Cal will likely continue to face limited access to care.

6-Month Agency Response

DHCS continues to disagree with the recommendation. DHCS does agree the number of physicians practicing in California would be beneficial for all health care delivery systems. As such DHCS has enacted the CalHealthCares program to increase access to preventive health services for children in areas where they are needed most. Further, in the 2022-2023 state budget, DHCS proposed additional allocation of funding for the program when minimum Medical Loss Ratio is not met by MCPs. The program has focused on supporting providers in under resourced communities.

DHCS anticipates 99 percent of beneficiaries will be enrolled in Medi-Cal MCPs by 2024. DHCS is committed to ensuring MCP networks are sufficient to ensure timely access to care for Medi-Cal members. DHCS has a robust process for reviewing networks, certifying adequacy, and refining processes to improve monitoring of networks and timely access to care. Current monitoring activities include surveying providers to assess compliance with appointment wait time standards; monitoring access to care grievances; and network certifications of MCPs. DHCS continually evaluates the processes to improve our ability to monitor and oversee MCP compliance with network adequacy requirements.

California State Auditor's Assessment of 6-Month Status: Will Not Implement

Although DHCS asserts that it has taken some steps to ensure that health plans provide timely access to care, without a targeted effort by DHCS to increase the number of Medi-Cal providers in underserved areas, children in Medi-Cal will likely continue to face limited access to care.

60-Day Agency Response

DHCS will not fully implement Recommendation 8. However, DHCS has enacted the CalHealthCares program. Further, in the 2022-2023 state budget, DHCS proposed additional allocation of funding for the program when the minimum MLR is not met by MCPs. The program has focused on supporting providers in under resourced communities.

DHCS anticipates 99 percent of beneficiaries will be enrolled in Medi-Cal MCPs by 2024. DHCS is committed to ensuring MCP networks are sufficient to ensure timely access to care for Medi-Cal members. DHCS has a robust process for reviewing networks, certifying adequacy, and refining the DHCS process to improve monitoring of networks and timely access to care. Current monitoring activities include surveying providers to assess compliance with appointment wait time standards; monitoring access to care grievances; and network certifications of MCPs. DHCS continually evaluates the processes to improve ability to monitor and oversee MCP compliance with network adequacy requirements.

California State Auditor's Assessment of 60-Day Status: Will Not Implement

Although DHCS asserts that it has taken some steps to ensure that health plans provide timely access to care, without a targeted effort by DHCS to increase the number of Medi-Cal providers in underserved areas, children in Medi-Cal will likely continue to face limited access to care.

All Recommendations in 2022-502

Agency responses received are posted verbatim.