MEDI-CAL: Audit Finds Serious Shortcomings In Managed Care Plans
"Fewer than half of the children and pregnant women in some state-funded programs got the health care they needed," according to a Health Services Advisory Group audit of the "quality of care for the 2.4 million people enrolled in Medi-Cal's managed care programs." The AP/Bakersfield Californian reports that in addition to providing "inconsistent and inadequate" health care, eight Medi-Cal programs were missing medical records for "one out of every three patients." The audit found that California's Medi-Cal programs compared unfavorably with similar programs in New York and Arizona in the "quality of prenatal and postpartum care." A major reason for "the low scores was poor record keeping" -- providers were given ten weeks to provide the requested patient records and "missing records were treated as a lack of care." The AP/Bakersfield Californian reports that in one case, "half the requested charts were not provided" by Alameda Alliance for Health. "If you're going to do managed care and you can't find your records, that's a problem," said Dan Rabovsky of the Legislative Analyst's Office.
Following the Department of Health Services' expansion of the Medi-Cal managed care program over the past five years, enrollment has "swelled" to 2.4 million Californians. However, the "federally mandated audit" is the first to assess the managed care programs. The Department of Health Services intends to evaluate all 22 Medi-Cal programs before the end of the year. "We're not happy with the results," said California Department of Health Services spokesperson Ken August. "We think the plans can do better. We expect to see the plans improve and we expect to use this as a tool to encourage the plans to improve," he added (8/12).