Report 2023-115 Recommendation 13 Responses

Report 2023-115: Department of Health Care Services and Department of Managed Health Care: Children Enrolled in Medi-Cal Face Challenges in Accessing Behavioral Health Care (Release Date: November 2023)

Recommendation #13 To: Health Care Services, Department of

To ensure that Medi-Cal managed care plans have a sufficient number of providers to offer timely access and meet children's behavioral health care needs, by May 2024, DHCS should develop a new methodology for calculating non-specialty outpatient behavioral health provider-to-member ratios. At minimum, the methodology should consider the following factors:
-The expected demand for behavioral health services by children in Medi-Cal, based on factors including but not limited to past services.
-The estimated number of children likely to need those services.
-The number of full-time providers needed to provide that volume of services.
-The amount of time individual providers spend treating Medi-Cal members.
The methodology should also accommodate potential growth in the need for behavioral health services.

60-Day Agency Response

By May 2024, DHCS will conduct an analysis to consider the above-recommended factors and update the provider-to-member ratio methodology accordingly. DHCS is planning the analysis and has begun research into studies to address mental health provider-to-member ratios. In developing an updated methodology, DHCS will consider the feasibility of each of the recommended factors based on available data.

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

All Recommendations in 2023-115

Agency responses received are posted verbatim.