Report 2018-122 Recommendation 14 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 #14 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 it has the financial resources to provide assistance to counties interested in establishing a COHS or other managed care model after the current Regional Model contracts expire. If DHCS does not have the required financial resources, it should seek an appropriate amount of funding from the Legislature.

Annual Follow-Up Agency Response From October 2021

DHCS continues to disagree with the recommendation. As stated in the previous responses, DHCS' role is to monitor and ensure the compliance of each MCP. The counties are autonomous entities and are responsible for deciding on and pursuing the best model type for the service area.

However, based on current activities and guidance around potential County Plan Model Changes, DHCS has provided extensive technical assistance to counties, including various regional model counties, as well as to MCPs interested in expanding into the rural counties. DHCS will continue to be a resource to both Counties and Plans interested in changing the Plan Model type that operates in their county.

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

Because the Regional Model includes many counties that may desire to transition to a single multicounty COHS, we believe that it would be more effective for DHCS to submit a consolidated funding request to the Legislature rather than for each county to submit its own individual request. As we state on page 7 of the report, DHCS is the state agency responsible for administering Medi-Cal. Regardless of its position on its role, DHCS would help expedite authorization of such funding by submitting a single request and would also help ensure that all of the counties are treated equitably, despite differences in their size and resources. As we characterize on page 42 of the report, small and rural counties may not be able to develop the infrastructure required to change their managed care models without DHCS' assistance.

1-Year Agency Response

DHCS continues to disagree with the recommendation. DHCS' role is to monitor and ensure the compliance of each MCP. The counties are autonomous entities and are responsible for deciding on and pursuing the best model type for the service area. DHCS does not have the financial resources to provide direct monetary assistance, and requesting the Legislature to provide financial incentives for counties to pursue a single model type is outside DHCS' purview. However, DHCS will lead any statutory changes necessary to account for a plan model change in the counties.

Alternatively, the Legislature may decide to provide funding for a county or combination of counties and weigh against other budget priorities. The appropriate entity would have to be determined to conduct the work.

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

We continue to disagree with DHCS' perspective. Because the Regional Model includes many counties that may desire to transition to a single multicounty COHS, we believe that it would be more effective for DHCS to submit a consolidated funding request to the Legislature rather than for each county to submit its own individual request. As we state on page 7 of the report, DHCS is the state agency responsible for administering Medi-Cal. Regardless of its position on its role, DHCS would help expedite authorization of such funding by submitting a single request and would also help ensure that all of the counties are treated equitably, despite differences in their size and resources. As we characterize on page 42 of the report, small and rural counties may not be able to develop the infrastructure required to change their managed care models without DHCS' assistance.

6-Month Agency Response

DHCS continues to disagree with this recommendation. DHCS does not have the financial resources to provide direct financial assistance to counties to establish a Health Care Plan. Historically, the responsibility of establishing a COHS has been on the interested county to pursue. It is not within DHCS' purview to submit a request to the legislature, as it is not DHCS who dictates the plan model type that operates in the county, it is the DHCS' role to monitor and ensure compliance of each MCP. It is the counties' responsibility to initiate a request to change plan model types. However, DHCS will lead any statutory changes necessary to account for a plan model change in the counties. Alternatively, the Legislature may decide that it wishes to provide funding for a county or combination of counties and it would be weighed against other budget priorities of the administration. The appropriate entity would then have to be determined to conduct the work.

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

We continue to disagree with DHCS' perspective. Because the Regional Model includes many counties that may desire to transition to a single multicounty COHS, we believe that it would be more effective for DHCS to submit a consolidated funding request to the Legislature rather than for each county to submit its own individual request. As we state on page 7 of the report, DHCS is the state agency responsible for administering Medi-Cal. Regardless of its position on its role, DHCS would help expedite authorization of such funding by submitting a single request and would also help ensure that all of the counties are treated equitably, despite differences in their size and resources. As we characterize on page 42 of the report, small and rural counties may not be able to develop the infrastructure required to change their managed care models without DHCS' assistance.

60-Day Agency Response

DHCS continues to disagree with this recommendation. DHCS does not have the financial resources to provide direct financial assistance to counties to establish a Health Care Plan. Historically, the responsibility of establishing a COHS has been on the interested county. Alternatively, the Legislature may decide that it wishes to provide funding for a county or combination of counties and it would be weighed against other budget priorities of the administration. The appropriate entity would then have to be determined to conduct the work.

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

As we stated in our comments on DHCS' original response to the audit report, we disagree with DHCS' perspective. Because the Regional Model includes many counties that may desire to transition to a single multicounty COHS, we believe that it would be more effective for DHCS to submit a consolidated funding request to the Legislature rather than for each county to submit its own individual request. As we state on page 7 of the report, DHCS is the state agency responsible for administering Medi-Cal. By submitting a single request, DHCS would help expedite authorization of such funding and would also help ensure that all of the counties are treated equitably, despite differences in their size and resources. As we characterize on page 42 of the report, small and rural counties may not be able to develop the infrastructure required to change their managed care models without DHCS' assistance.

All Recommendations in 2018-122

Agency responses received are posted verbatim.