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Medi-Cal Managed Care Audit Coming

The California State Auditor on Tuesday is slated to release a report 10 months in the making that will analyze the efficacy of the Medi-Cal managed care program. Medi-Cal is California’s Medicaid program.

The state auditor’s office, which began its evaluation in August 2014, announced it will release the report on Tuesday.

The report is billed as offering an independent assessment of a number of aspects of the Medi-Cal managed care program, including:

  • Accuracy of provider directories;
  • Adequacy of provider networks;
  • Appropriateness of the regulatory oversight structure for the Department of Managed Health Care and the Department of Health Care Services, which oversee Medi-Cal managed care;
  • Sufficiency of those departments’ policies, staffing and procedures to ensure accurate provider directories and adequate provider networks; and
  • Determination of managed care plans’ verification of provider network data to those two departments.

To reach its conclusions, the state auditor looked at Medi-Cal managed care plans in three counties to see how they meet requirements for adequate access to providers and accuracy of directories.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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