Report 2023-115 Recommendation 13 Responses

Report 2023-115: Department of Health Care Services and Department of Managed Health Care: Children Enrolled in Medi-Cal Face Challenges in Accessing Behavioral Health Care (Release Date: November 2023)

Recommendation #13 To: Health Care Services, Department of

To ensure that Medi-Cal managed care plans have a sufficient number of providers to offer timely access and meet children's behavioral health care needs, by May 2024, DHCS should develop a new methodology for calculating non-specialty outpatient behavioral health provider-to-member ratios. At minimum, the methodology should consider the following factors:
-The expected demand for behavioral health services by children in Medi-Cal, based on factors including but not limited to past services.
-The estimated number of children likely to need those services.
-The number of full-time providers needed to provide that volume of services.
-The amount of time individual providers spend treating Medi-Cal members.
The methodology should also accommodate potential growth in the need for behavioral health services.

6-Month Agency Response

DHCS conducted an analysis to consider the above-recommended factors and updated the provider-to-member ratio methodology accordingly. The analysis was focused on addressing the items feasible for implementation by May 2024. It was determined feasible to include the number of full-time equivalent providers needed and the amount of time providers spend serving Medi-Cal patients in the methodology. DHCS will continue to perform research on the other recommended factors based on available data and will target inclusion with the 2024 annual network certification (ANC).

California State Auditor's Assessment of 6-Month Status: Partially Implemented

DHCS provided a revised methodology that includes some of the elements of our recommendation. When DHCS finalizes its methodology and provides documentation of its consideration of all factors included in the recommendation, we will assess whether DHCS has fully implemented the recommendation.

60-Day Agency Response

By May 2024, DHCS will conduct an analysis to consider the above-recommended factors and update the provider-to-member ratio methodology accordingly. DHCS is planning the analysis and has begun research into studies to address mental health provider-to-member ratios. In developing an updated methodology, DHCS will consider the feasibility of each of the recommended factors based on available data.

California State Auditor's Assessment of 60-Day Status: Pending

All Recommendations in 2023-115

Agency responses received are posted verbatim.