Report 2018-122 Recommendation 13 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 #13 To: Health Care Services, Department of

To ensure that beneficiaries in the Regional Model counties have reasonable access to care, DHCS should evaluate by June 2020 whether the structural characteristics of a COHS Model would be better suited to providing reasonable access to care in the Regional Model counties and notify the counties whether a COHS would improve beneficiaries' access to care. If some or all of these counties desire to transition to a COHS, DHCS should assist them in making that change after their current contracts expire.

Annual Follow-Up Agency Response From October 2021

On February 2, 2021, DHCS as part of the statewide procurement of commercial Medi-Cal managed care plans, released Letter of Intent instructions for counties that intend to transition to a local Medi-Cal managed care plan model by January 2024 (either a Two-Plan or COHS model). To begin the model change process, DHCS required counties to submit either a preliminary letter of interest or a full letter of intent by March 31. The purpose of the Letter of Intent is for the county to demonstrate understanding of the MCP's obligations as a new local plan, describe county engagement underway, and outline the necessary steps in order to meet the preliminary requirements prior to the finalization of the commercial plan procurement RFP in 2021. DHCS provided technical assistance to counties during this process. The implementation date for commercial plans procured in the RFP, and any new local plans, is January 1, 2024. See Letter of Intent Instructions for further detail.

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

DHCS describes its efforts to assist counties that desire to transition to a COHS model, although it does not state any action taken to evaluate whether the structural characteristics of that model would be better suited to providing reasonable access to care in the Regional Model counties.

1-Year Agency Response

DHCS is reviewing the recommendations in the EQRO Regional Model Access Focused Study Report, and will determine any actionable steps.

California State Auditor's Assessment of 1-Year Status: Will Not Implement

Although DHCS states that it will not implement this recommendation, it indicates that it may take action to address access to care based on the results of the analysis cited in Recommendation 12.

6-Month Agency Response

DHCS continues to work towards the analysis of the Regional Model as noted in recommendation 12 and will determine next steps through that effort.

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

Although DHCS states that it will not implement this recommendation, it indicates that it may take action to address access to care based on the results of the analysis cited in Recommendation 12.

60-Day Agency Response

DHCS continues to work towards the analysis of the Regional Model as noted in Recommendation 12 and will determine next steps through that effort.

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

Although DHCS states that it will not implement this recommendation, it indicates that it may take action to address access to care based on the results of the analysis cited in Recommendation 12.

All Recommendations in 2018-122

Agency responses received are posted verbatim.