State Audit Ordered Over Access in Medi-Cal Managed Care Plans
On Thursday, a California legislative committee ordered an audit to determine whether the state is providing Medi-Cal managed care plan beneficiaries adequate access to health care services, the Los Angeles Times reports.
Medi-Cal is California's Medicaid program (Megerian, Los Angeles Times, 8/14).
Currently, more than seven million state residents -- or about 20% of California's population -- are enrolled in a Medi-Cal managed care plan (Guzik, HealthyCal, 8/14).
Medi-Cal is the state's largest expense after the school system and is expected to cover one in three state residents by 2015.
However, the current state budget continues a 10% cut in Medi-Cal reimbursements to some health care providers, and physicians have said the decreased reimbursements have forced them to limit how many Medi-Cal patients they accept.
Further, there is a backlog of about 400,000 pending Medi-Cal applications that likely will further strain the program once they are processed, the Times reports.
Details of Audit
In a letter to the legislative committee, state Sen. Ricardo Lara (D-Bell Gardens) requested the audit after his office "received several alarming reports" about Medi-Cal beneficiaries having trouble accessing care (Los Angeles Times, 8/14).
According to HealthyCal, the audit will take six to eight months and cost about $287,000.
Specifically, the audit will gauge:
- Whether Medi-Cal's managed-care provider directories include an adequate number of physicians who are accepting new patients through the program; and
- Whether state lawmakers have been properly overseeing the directories (HealthyCal, 8/14).
Mari Cantwell, chief deputy director of health care programs at the state Department of Health Care Services, said officials have not experienced or identified widespread issues. However, she said that managed care plans are working to meet demand for care and that the state is tracking such efforts (Los Angeles Times, 8/14).
Meanwhile, the California Association of Health Plans blamed physicians for directory inaccuracies, according to HealthyCal.
CAHP President and CEO Patrick Johnston in a statement said, "Medi-Cal managed care plans work hard to keep their online provider directories up-to-date, however, they rely upon doctors to inform them when they stop accepting new patients, offices move or doctors retire." He added, "Health plans need accurate information from providers in order to have accurate directories."
The California Medical Association said insurers often make errors on provider lists, even after physicians say they are no longer accepting patients (HealthyCal, 8/14).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.