Report 2018-111 Recommendation Responses
Report 2018-111: Department of Health Care Services: Millions of Children in Medi-Cal Are Not Receiving Preventive Health Services (Release Date: March 2019)
Recommendation for Legislative Action
To improve the health of California's children, the Legislature should direct DHCS to implement financial incentives, such as a pay-for-performance program, designed to help ensure that plans are more consistently providing preventive services to children in Medi-Cal. To the extent DHCS can demonstrate that additional funding is necessary to operate such a program, the Legislature should increase funding specifically for that purpose.
Description of Legislative Action
SB 773 (Roth, 2022) would, commencing with the January 1, 2022, rating period, and through December 31, 2024, require DHCS to make incentive payments to qualifying Medi-Cal managed care plans that meet predefined goals and metrics associated with targeted interventions, rendered by school-affiliated behavioral health providers, that increase access to preventive, early intervention, and behavioral health services for children enrolled in kindergarten and grades 1 to 12. The bill would require DHCS to consult with certain stakeholders on the development of interventions, goals, and metrics, to determine the amount of incentive payments, and to seek any necessary federal approvals. The bill would condition the issuance of incentive payments on compliance with federal requirements and the availability of federal financial participation. Alternatively, if federal approval is not obtained, the bill would authorize DHCS to make incentive payments on a state-only funding basis, but only to the extent DHCS determines that federal financial participation for the Medi-Cal program is not otherwise jeopardized. As of March 14, 2022, this bill is pending in the Senate.
- Legislative Action Current As-of: March 2022
California State Auditor's Assessment of Annual Follow-Up Status: Legislation Introduced
Description of Legislative Action
As of March 14, 2021, the Legislature has not taken action to address this specific recommendation.
- Legislative Action Current As-of: March 2021
California State Auditor's Assessment of Annual Follow-Up Status: No Action Taken
Description of Legislative Action
As of March 14, 2020, the Legislature has not taken action to address this specific recommendation.
- Legislative Action Current As-of: March 2020
California State Auditor's Assessment of 1-Year Status: No Action Taken
Description of Legislative Action
AB 537 (Arambula) would have required, commencing January 1, 2022, a Medi-Cal managed care plan to meet a minimum performance level (MPL) that improves the quality of health care and reduces health disparities for enrollees. The bill would have required DHCS to establish both a quality assessment and performance improvement program and a value-based financial incentive program to ensure that a Med-Cal managed care plan achieves an MPL. This bill was held in the Assembly Appropriations Committee.
- Legislative Action Current As-of: October 2019
California State Auditor's Assessment of 6-Month Status: Legislation Proposed But Not Enacted
Description of Legislative Action
AB 537 (Wood) would require DHCS to develop a plan for a value-based financial incentive program to reward a high-performing Medi-Cal managed care plan that meets performance targets that demonstrate health care quality improvement and health disparities reduction. DHCS would be required to utilize the results of the quality assessment and performance improvement program to develop a publicly reported Quality Rating System for Medi-Cal plans, and establish a public stakeholder process in the planning, development, and ongoing oversight of the quality assessment and performance improvement program and the value-based financial incentive program.
- Legislative Action Current As-of: May 2019