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Complaints, Specialty Services at Issue in Healthy Families Transition

State health officials said some of the official numbers may be a little low in monitoring the transition of children from Healthy Families to Medi-Cal managed care plans.

At last week’s meeting of the Managed Risk Medical Insurance Board, MRMIB executive director Janette Casillas said that, having overseen the Healthy Families program for so long, she sees some anomalies when looking at recent transition-monitoring numbers from the Department of Health Care Services.

“My observation in reviewing the monitoring is that the data appears to be understated,” Casillas said, referring to the low number of complaints and grievances DHCS has reported it received during the transition. Casillas said the few complaints received by the department could mean the bulk of complaints are going elsewhere.

“I know, just from running the children’s program, you get complaints of all sorts. And if you look at the [written DHCS] material, they always say if you have questions, call your health plans,” Casillas said. “But what’s missing is the phone volume from the health plans. That’s a good data point that’s not in these reports, and we need to see: Are there areas where we need to devote more resources?”

Casillas said she has always been impressed by the help desk at the Department of Managed Health Care, and its ability to code the complaints it receives. She suggested those methods could be used by health plans.

She also said the number of children receiving autism, dental and mental health services seems low. Given the more than 600,000 children who have made the transition so far, there should be more than 418 of those children receiving mental health services, Casillas said.

“The numbers that the department calls out appear to be quite understated,” she said. “… The majority of mental health-type services are provided in our health plan, and the number of children they’ve noted — 418 of them — is actually quite low.”

Rene Mollow, deputy director of benefits and eligibility at DHCS, said the department has conducted a beneficiary survey as a CMS requirement of approval, and it will continue to expand on those survey results, which were generally positive, she said. 

“I do appreciate the comments [at the MRMIB board meeting],” Mollow said. “We take very seriously the work to transition the Healthy Families kids.” For the survey, she said, “about 10,0000 calls were made, but we didn’t get a lot of responses on that. The survey will be an ongoing process. It is something required of us, and we are doing that.”

As for the concerns about access to specialty services, “We have been working hard to follow up in terms of health care services,” Mollow said. “In terms of autism, we are continuing to get new information and a better assessment of what services they’re getting. This issue is very important to us.”

Casillas said “My concern is, we may not be using every data source that’s available to us. It’s important to understand where we need to allocate our resources.”

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