Report 2018-122 Recommendation 1 Responses

Report 2018-122: Department of Health Care Services: It Has Not Ensured That Medi-Cal Beneficiaries in Some Rural Counties Have Reasonable Access to Care (Release Date: August 2019)

Recommendation #1 To: Health Care Services, Department of

To ensure that beneficiaries in Regional Model counties have adequate access to care, DHCS should identify by August 2020 the locations requiring additional providers and the types of providers required. It should also develop strategies for recruiting and retaining providers in those locations. If it requires additional funding to complete this assessment or to implement actions to address its findings, DHCS should determine the amounts it needs and request that funding from the Legislature.

Annual Follow-Up Agency Response From October 2021

DHCS obtained network recruitment strategies from two Regional Model Medi-Cal MCPs, Anthem and California Health & Wellness. The Regional Model MCPs identified their approaches on outreach to expand their networks, such as focused communications to specialists, providers that are contracted with other MCPs, and providers in bordering counties outside the MCPs' counties. They have also encouraged their commercial providers to offer services to Medi-Cal beneficiaries and have used provider incentives to attract new providers in the network, including offering contracts above standard Medi-Cal rates. Further, to promote provider relationships, the MCPs have established designated teams to onboard new providers, address provider concerns, and offer continuous support. Lastly, both MCPs have expanded their use of telehealth services. These strategies aim to improve access to care for their Medi-Cal members.

California State Auditor's Assessment of Annual Follow-Up Status: Will Not Implement

Annual Follow-Up Agency Response From November 2020

DHCS does agree that increasing the number of physicians who practice in Regional Model counties is beneficial for all health care delivery systems.

Specific to Medi-Cal providers, Proposition 56 provided a one-time allocation of $340 million for a loan repayment program for recently graduated physicians and dentists. The selection of physicians and dentists for participation is based on eligibility criteria and prioritizing those agreeing to work in geographic shortage areas to increase access to care for Medi-Cal beneficiaries. In October 2019, DHCS provided network analysis data to Physicians for a Healthy California to assist with focusing the loan repayment program efforts on areas with access concerns. Additionally, DHCS will request the health plans conduct an assessment and submit to DHCS a recruitment strategy for areas in the Regional Model not compliant with time and distance standards. The assessment would be due to DHCS three months after the next annual network certification is completed.

Estimated Completion Date:

California State Auditor's Assessment of Annual Follow-Up Status: Will Not Implement

1-Year Agency Response

DHCS does agree that increasing the number of physicians who practice in Regional Model counties is beneficial for all health care delivery systems.

Response Date: August 2020

California State Auditor's Assessment of 1-Year Status: Pending

Although DHCS indicated that it will not implement our recommendation, the actions it describes appear to address the concerns underlying the recommendation. If DHCS follows through with its proposed actions or other similar efforts, we may subsequently be able to conclude that the recommendation has been sufficiently resolved. Accordingly, we have assessed the implementation status as pending.

6-Month Agency Response

DHCS continues to disagree with this recommendation for DHCS to identify strategies for recruiting and retaining providers in the regional model counties. However, Proposition 56 provided a one-time allocation of $340 million for a loan repayment program for recently graduated physicians and dentists. The selection of physicians and dentists for participation is based on eligibility criteria and prioritizing those agreeing to work in geographic shortage areas to increase access to care for Medi-Cal beneficiaries. DHCS contracted with Physicians for a Healthy California to administer the loan repayment program, CalHealthCares. To help with efforts to better target specific areas with access concerns, DHCS provided network analysis data to Physicians for a Healthy California in October 2019.

Response Date: January 2020

California State Auditor's Assessment of 6-Month Status: Will Not Implement

It remains unclear why DHCS disagrees with this recommendation. Although the efforts it describes may result in recruiting some additional providers, our recommendation focuses on DHCS performing a thorough assessment of the locations requiring such providers and developing strategies for their recruitment and retention.

60-Day Agency Response

DHCS continues to disagree with this recommendation. DHCS does agree that increasing the number of physicians who practice in California is beneficial for all health care delivery systems; however, such assessment is not in the purview of DHCS.

Response Date: October 2019

California State Auditor's Assessment of 60-Day Status: Will Not Implement

It is unclear why DHCS does not believe that addressing this recommendation is within its purview, given its role in overseeing the State's provision of Medi-Cal services and ensuring that Medi-Cal recipients have access to medical care that state law requires.

All Recommendations in 2018-122

Agency responses received are posted verbatim.