Monthly Medi-Cal Complaint Investigations Up 82% This Year

California Department of Health Care Services investigations involving consumers with serious or complicated issues related to Medi-Cal increased by more than 80% this year, HealthyCal reports. Medi-Cal is the state's Medicaid program.

DHCS' Managed Care Ombudsman Office is in charge of responding to Medi-Cal concerns (Guzik, HealthyCal, 8/7).

Background on Medi-Cal Expansion

Under the ACA, a state expansion of Medi-Cal allows individuals with incomes up to 138% of the federal poverty level, or $15,415 annually, to gain coverage (California Healthline, 9/18/13).

However, a spokesman for the state on Aug. 1 said that 490,000 Medi-Cal applications still are awaiting verification (California Healthline, 8/4).

Details of Caseload

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.

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.

DHCS spokesperson Norman 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."

As a result of the increase in communications, the number of cases of serious or complicated issues also increased.  About 44% of calls and emails in the first six months of this year resulted in cases, compared with 32% in all of 2013.

Between January and June, the Ombudsman Office investigated about 9,466 cases per month -- an 82% increase over the monthly average in 2013. So far this year, the office has received 56,793 cases, compared with 54,813 in all of 2013.

However, Williams noted that the office does not track the number of missed calls and emails, such as when individuals hang up after being placed on hold. The office also does not record the length of time it takes to resolve cases.

DHCS Response

Williams said the Ombudsman Office has hired 12 additional workers -- for a total of 21 employees -- to address consumers' concerns and questions.

In addition, he said that DHCS is upgrading its software to track the number of consumers who called or emailed the Ombudsman Office multiple times (HealthyCal, 8/7).