The state departments of Health Care Services and Managed Health Care have been deficient in reviewing the finances of Medi-Cal managed care plans, according to an audit from State Auditor Elaine Howle, the Los Angeles Times reports. Medi-Cal is California's Medicaid program.
There are about 7.6 million Medi-Cal beneficiaries in the state, about 4.3 million of whom receive services through managed care plans. The state is shifting more beneficiaries into such plans in an effort to reduce costs.
Sen. Michael Rubio (D-East Bakersfield) requested the audit after becoming concerned that the plans had significantly high amounts of unspent state funds.
DHCS is tasked with ensuring that managed care plans comply with Medi-Cal rules, while DMHC oversees the plans' financial viability.
Details of the Audit Report
The audit found that DHCS and DMHC did not check in a timely manner that Medi-Cal beneficiaries were receiving high-quality care.
DMHC was "chronically late" in completing financial reviews and took an average of 200 days to finish them, according to the audit. The agency also failed to detect that some plans' administrative costs were categorized incorrectly as medical expenses.
Howle's office also found that some of DHCS' financial reviews were incomplete and that some medical audits were not completed quickly enough.
DMHC said it has taken action to "strengthen our financial oversight of local health initiatives."
Tony Cava, a spokesperson for DHCS, said the agency is working to implement policies that ensure consistent and timely reviews. Cava added that DHCS also plans to restart yearly medical audits of Medi-Cal managed care plans beginning early next year. The department stopped conducting such audits three years ago (Gorman, Los Angeles Times, 12/14).