Delay in Reports From Office in Charge of Medi-Cal Complaints

The California Department of Health Care Services unit in charge of handling Medi-Cal beneficiaries' problems or complaints has not released a quarterly report in nearly 12 months, HealthyCal reports.

Medi-Cal is California's Medicaid program (Guzik, HealthyCal, 8/26).

Background

DHCS' Managed Care Ombudsman Office is in charge of responding to Medi-Cal concerns.

In the first six months of this year, the Ombudsman Office received an average of 21,689 calls and emails per month, compared with 14,381 calls and emails per month in 2013 -- a 51% increase.

DHCS spokesperson Norman Williams said that a review this month found that calls and emails to the office included:

• Complaints, accounting for 4% of calls;
• Requests for expedited enrollment or unenrollment, accounting for 60% of calls; and
• Questions about other issues, such as eligibility and continuity of care.

Williams said that "a high volume of contacts to the Ombudsman" since the expansion of Medi-Cal have been "related to health care plan issues, including how to access services or who to contact at the plan level with specific questions" (California Healthline, 8/8).

The Ombudsman's Office generally produces a report every three months, showing:

• The number of cases handled for each managed-care plan in the state; and
• The types of cases handled.

However, the office has not released a report since September 2013.

The reports are used to identify problems in managed-care programs, but DHCS spokesperson Anthony Cava noted that the agency is not required to produce the reports.

Details of Delay

Williams said the reports have been delayed because the agency's "case volume has increased significantly," which "adds to the length of time the Ombudsman Office will need to produce the reports."

Beginning in November, the office plans to release four quarterly reports covering data from October 2013 to September 2014.

According to Williams, the reports released later this year "will more accurately report all of the avenues of access to the Ombudsman," including email and Web-based forms. The reports previously only included phone calls to the agency. In addition, he said new reports will include information on how many cases were resolved (HealthyCal, 8/26).