June 16--An audit released Tuesday found California hasn't properly ensured that patients who are part of its Medi-Caid program have adequate access to doctors.
The report from the California state auditor's office found that provider directories for Medi-Cal managed care plans were riddled with errors, including incorrect telephone numbers and listings for doctors who are no longer part of the plans, and that the state's Department of Health Care Services needs to improve its oversight of the plans.
Medi-Cal is the name of California's Medi-Caid program.
Eligibility for Medi-Cal, the state's health program for the poor, was expanded under the Affordable Care Act. Since last year, enrollment has exploded, with more than 3.5 million people signing up for the first time. Nearly one in three Californians -- a total of 12.2 million people -- now receive coverage through Medi-Cal.
That has raised concerns about whether patients can get the care they need. Last year, Sen. Ricardo Lara (D-Bell Gardens) requested the audit, saying he'd heard from Medi-Cal patients who were struggling to find doctors.
The audit evaluated the provider directories of three health plans -- Anthem Blue Cross in Fresno County, Partnership HealthPlan of California in Solano County and Health Net in Los Angeles County -- and found that they contained inaccurate information for 3% to 23% of providers. Despite these errors, the Department of Health Care Services had not found "any inaccuracies in the three provider directories we examined," according to the audit.
The audit also found that department's office of the ombudsman, which is supposed to resolve complaints from beneficiaries, has been overwhelmed with more calls than the office's telephone system can handle.
Between 7,000 and 45,000 calls were rejected each month between February 2014 and January 2015, according to the audit. And inadequate staffing has meant that only between 30% and 50% of the calls the telephone system accepts are actually answered, meaning an additional 12,500 calls were unanswered each month during that time period, the audit found.
The audit recommends that the Department of Health Care Services improve its process for verifying plan data, and establish a clear process to do so by September of this year. It also recommends that it upgrade or replace the telephone system at the office of the ombudsman.
The department generally agreed with the recommendations and outlined actions it will take to implement them, according to the audit.
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UPDATES
10:18 a.m.: This article was updated with findings from the audit.
The first version of this article was published at 7:24 a.m.
