Report 2018-603 All Recommendation Responses

Report 2018-603: Department of Health Care Services: It Paid Billions in Questionable Medi-Cal Premiums and Claims Because It Failed to Follow Up on Eligibility Discrepancies (Release Date: October 2018)

Recommendation for Legislative Action

To ensure that Health Care Services adequately monitors the counties' resolution of system discrepancies, the Legislature should require Health Care Services to report publicly on counties' compliance with the performance standards set forth in state law, as well as Health Care Services' actions taken in response to counties not complying with the standards.

Description of Legislative Action

As of October 22, 2022, the Legislature has not taken action to address this specific recommendation.

California State Auditor's Assessment of Status: No Action Taken

Description of Legislative Action

As of October 30, 2021, the Legislature has not taken action to address this specific recommendation.

California State Auditor's Assessment of Status: No Action Taken

Description of Legislative Action

As of October 30, 2020, the Legislature has not taken action to address this specific recommendation.

California State Auditor's Assessment of Status: No Action Taken

Description of Legislative Action

As of September 2019, the Legislature has not taken action to address this specific recommendation.

California State Auditor's Assessment of Status: No Action Taken

Description of Legislative Action

The Legislature has not taken any action to address this specific recommendation.

California State Auditor's Assessment of Status: No Action Taken

Description of Legislative Action

The Legislature has not taken action to address this specific recommendation.

California State Auditor's Assessment of Status: No Action Taken

Recommendation #2 To: Health Care Services, Department of

To recover inappropriately spent funds, prevent future erroneous payments, and ensure eligible individuals' access to care, Health Care Services should resolve the discrepancies we identified and recover erroneous payments where allowable by June 30, 2019.

DHCS continues to work with counties to resolve all records identified as discrepant. To expedite the process, in collaboration with Statewide Automated Welfare Systems (SAWS), DHCS performed an automated match process between Medi-Cal Eligibility Database System (MEDS) and SAWS to reconcile beneficiary status in both systems. While effective, the effort remains labor intensive and protracted; consequently, DHCS implemented additional measures:

- DHCS and the five counties responsible for 85 percent of the discrepant records are in the process of collectively strategizing to develop a path forward in reconciling records.

- DHCS plans to meet with the five counties separately to further discuss the development of a reconciliation process.

- An in-person training session for the five counties was scheduled to address any issues attributing to the creation of new MEDS alerts at the county level, and to provide technical guidance on problematic records.

- DHCS requests counties provide best practices for resolving MEDS alerts for DHCS' review.

- DHCS developed various exercises for counties to perform to gain a better understanding of actions which contribute to the critical/high-volume alerts.

Due to the COVID-19 Public Health Emergency (PHE) and the federal requirement to delay renewals until the end of the PHE, DHCS was not able to implement the planned actions last year. DHCS will resume the stated plan in June 2024 when the unwind ends.

The Biden Administration declared the PHE was set to end on May 11, 2023. The continuous coverage requirements ended on March 31, 2023, and the unwinding of the continuous coverage requirement began April 1, 2023. CMS issued a series of State Health Official (SHO) letters (December 2020, August 2021, March 2022) detailing federal expectations and requirements of case processing timeliness and beneficiary communications for redetermining Medi-Cal coverage for individuals who had coverage continuously maintained during the PHE.

California State Auditor's Assessment of Status: Pending

DHCS does not expect to fully implement this recommendation until June 2024.

DHCS continues to work with counties to resolve all records identified as discrepant. To expedite the process, in collaboration with Statewide Automated Welfare Systems (SAWS), DHCS performed an automated match process between Medi-Cal Eligibility Database System (MEDS) and SAWS to reconcile beneficiary status in both systems. While effective, the effort remains labor intensive and protracted; consequently, DHCS implemented additional measures:

- DHCS and the five counties responsible for 85 percent of the discrepant records are in the process of collectively strategizing to develop a path forward in reconciling records.

- DHCS plans to meet with the five counties separately to further discuss the development of a reconciliation process.

- An in-person training session for the five counties was scheduled to address any issues attributing to the creation of new MEDS alerts at the county level, and to provide technical guidance on problematic records.

- DHCS requests counties provide best practices for resolving MEDS alerts for DHCS' review.

- DHCS developed various exercises for counties to perform to gain a better understanding of actions that contribute to the critical/high-volume alerts.

However, in response to the COVID-19 public health emergency, DHCS activated a disaster relief state plan amendment that allows counties to focus on application-processing and access to care. Currently, the Centers for Medicare and Medicaid Services granted DHCS authority to delay the processing of Medi-Cal redeterminations and allow beneficiaries to remain enrolled in the Medi-Cal program (with limited restrictions) regardless of any change in circumstance. DHCS has temporarily suspended the above efforts to allow counties the flexibility to modify business operations to ensure safety of staff and effectively meet the increase in community needs. DHCS will resume all efforts upon termination of the COVID-19 public health emergency.

California State Auditor's Assessment of Status: Pending

Per Health Care Services' response, it will not fully implement this recommendation until March 2024.

The estimated implementation date was extended by four months and is now 3/1/2024, due to an extension of the PHE for COVID-19. No changes from 45-Month Program Update.\

California State Auditor's Assessment of Status: Pending

Per Health Care Services' response, it will not implement this recommendation until March 2024.

The Estimated Implementation Date was extended by four months due to an extension of the PHE for COVID-19. Otherwise, no change from previous response. DHCS continues to work with counties to resolve all records identified as discrepant. To expedite the process, in collaboration with SAWS, DHCS performed an automated match process between MEDS and SAWS to reconcile beneficiary status in both systems. While effective, the effort remains labor intensive and protracted; consequently, DHCS implemented additional measures:

- DHCS and the five counties responsible for 85 percent of the discrepant records are in the process of collectively strategizing to develop a path forward in reconciling records.

- DHCS plans to meet with the five counties separately to further discuss the development of a reconciliation process.

- An in-person training session for the five counties was scheduled to address any issues attributing to the creation of new MEDS alerts at the county level, and to provide technical guidance on problematic records.

- DHCS requests counties provide best practices for resolving MEDS alerts for DHCS' review.

- DHCS developed various exercises for counties to perform to gain a better understanding of actions, which contribute to the creation of critical/high volume alerts.

However, in response to the COVID-19 PHE, DHCS activated the disaster state plan amendment, which allows counties to focus on application processing and access to care. Currently, CMS granted DHCS authority to delay the processing of Medi-Cal redeterminations and allow beneficiaries to remain enrolled in the Medi-Cal program (with limited restrictions) regardless of any change in circumstance. DHCS has temporarily suspended the above efforts to allow counties the flexibility to modify business operations to ensure safety of staff and effectively meet the increase in community needs. DHCS will resume all efforts upon termination of the federal COVID-19 PHE declaration.

California State Auditor's Assessment of Status: Pending

Per Health Care Services' response, it will not fully implement this recommendation until November 2023.

DHCS plans to move forward with the implementation plan provided in the previous update upon termination of the public health emergency with no modifications to the original plan. DHCS continues to work with counties to resolve all records identified as discrepant. To expedite the process, in collaboration with SAWS, DHCS performed an automated match process between MEDS and SAWS to reconcile beneficiary status in both systems. DHCS implemented additional measures:-DHCS and the five counties responsible for 85 percent of the discrepant records, are in the process of collectively strategizing to develop a path forward in reconciling records.-DHCS plans to meet with the five counties separately to further discuss the development of a reconciliation process.-An in-person training session for the five counties was scheduled to address any issues attributing to the creation of new MEDS alerts at the county level, and to provide technical guidance on problematic records.-DHCS requests counties provide best practices for resolving MEDS alerts for DHCS' review.-DHCS developed various exercises for counties to perform to gain a better understanding of actions, which contribute to the creation of critical/high volume alerts. However, in response to the COVID-19 public health emergency, DHCS activated the disaster state plan amendment, which allows counties to focus on application processing and access to care. Currently, CMS granted DHCS authority to delay the processing of Medi-Cal redeterminations and allow beneficiaries to remain enrolled in the Medi-Cal program (with limited restrictions) regardless of any change in circumstance. DHCS has temporarily suspended the above efforts to allow counties the flexibility to modify business operations to ensure safety of staff and effectively meet the increase in community needs. DHCS will resume all efforts upon termination of the federal COVID-19 public health emergency declaration.

California State Auditor's Assessment of Status: Pending

Per Health Care Services' response, it will not fully implement this recommendation until July 2023.

Response is unchanged from 36-Month update: DHCS continues to work with counties to resolve all records identified as discrepant. To expedite the process, in collaboration with SAWS, DHCS performed an automated match process between MEDS and SAWS to reconcile beneficiary status in both systems. While effective, the effort remains labor intensive and protracted; consequently, DHCS implemented additional measures:

- DHCS and the five counties responsible for 85 percent of the discrepant records are in the process of collectively strategizing to develop a path forward in reconciling records.

- DHCS plans to meet with the five counties separately to further discuss the development of a reconciliation process.

- An in-person training session for the five counties was scheduled to address any issues attributing to the creation of new MEDS alerts at the county level, and to provide technical guidance on problematic records.

- DHCS requests counties provide best practices for resolving MEDS alerts for DHCS' review.

- DHCS developed various exercises for counties to perform to gain a better understanding of actions, which contribute to the creation of critical/high volume alerts.

However, in response to the COVID-19 public health emergency, DHCS activated the disaster state plan amendment, which allows counties to focus on application processing and access to care. Currently, Centers for Medicare and Medicaid Services granted DHCS authority to delay the processing of Medi-Cal redeterminations and allow beneficiaries to remain enrolled in the Medi-Cal program (with limited restrictions) regardless of any change in circumstance. DHCS has temporarily suspended the above efforts to allow counties the flexibility to modify business operations to ensure safety of staff and effectively meet the increase in community needs. DHCS will resume all efforts upon termination of the COVID-19 public health emergency.

California State Auditor's Assessment of Status: Pending

Per Health Care Services' response, it will not fully implement this recommendation until December 2022.

Response is unchanged from 33-Month Update. DHCS continues to work with counties to resolve all records identified as discrepant. To expedite the process, in collaboration with SAWS, DHCS performed an automated match process between MEDS and SAWS to reconcile beneficiary status in both systems. While effective, the effort remains labor intensive and protracted; consequently, DHCS implemented additional measures:

- DHCS and the five counties responsible for 85 percent of the discrepant records are in the process of collectively strategizing to develop a path forward in reconciling records.

- DHCS plans to meet with the five counties separately to further discuss the development of a reconciliation process.

- An in-person training session for the five counties was scheduled to address any issues attributing to the creation of new MEDS alerts at the county level, and to provide technical guidance on problematic records.

- DHCS requests counties provide best practices for resolving MEDS alerts for DHCS' review.

- DHCS developed various exercises for counties to perform to gain a better understanding of actions, which contribute to the creation of critical/high volume alerts.

However, in response to the COVID-19 public health emergency, DHCS activated the disaster state plan amendment, which allows counties to focus on application processing and access to care. Currently, Centers for Medicare and Medicaid Services granted DHCS authority to delay the processing of Medi-Cal redeterminations and allow beneficiaries to remain enrolled in the Medi-Cal program (with limited restrictions) regardless of any change in circumstance. DHCS has temporarily suspended the above efforts to allow counties the flexibility to modify business operations to ensure safety of staff and effectively meet the increase in community needs. DHCS will resume all efforts upon termination of the COVID-19 public health emergency.

California State Auditor's Assessment of Status: Pending

Per Health Care Services' response, it will not fully implement this recommendation until December 2022.

Response is unchanged from 30-Month Update. DHCS continues to work with counties to resolve all records identified as discrepant. To expedite the process, in collaboration with SAWS, DHCS performed an automated match process between MEDS and SAWS to reconcile beneficiary status in both systems. While effective, the effort remains labor intensive and protracted; consequently, DHCS implemented additional measures:

- DHCS and the five counties responsible for 85 percent of the discrepant records are in the process of collectively strategizing to develop a path forward in reconciling records.

- DHCS plans to meet with the five counties separately to further discuss the development of a reconciliation process.

- An in-person training session for the five counties was scheduled to address any issues attributing to the creation of new MEDS alerts at the county level, and to provide technical guidance on problematic records.

- DHCS requests counties provide best practices for resolving MEDS alerts for DHCS' review.

- DHCS developed various exercises for counties to perform to gain a better understanding of actions, which contribute to the creation of critical/high volume alerts.

However, in response to the COVID-19 public health emergency, DHCS activated the disaster state plan amendment, which allows counties to focus on application processing and access to care. Currently, Centers for Medicare and Medicaid Services granted DHCS authority to delay the processing of Medi-Cal redeterminations and allow beneficiaries to remain enrolled in the Medi-Cal program (with limited restrictions) regardless of any change in circumstance. DHCS has temporarily suspended the above efforts to allow counties the flexibility to modify business operations to ensure safety of staff and effectively meet the increase in community needs. DHCS will resume all efforts upon termination of the COVID-19 public health emergency.

California State Auditor's Assessment of Status: Pending

Per the department's response, it will not fully implement this recommendation until December 2022.

Response is unchanged from 27-Month Update. DHCS continues to work with counties to resolve all records identified as discrepant. To expedite the process, in collaboration with SAWS, DHCS performed an automated match process between MEDS and SAWS to reconcile beneficiary status in both systems. While effective, the effort remains labor intensive and protracted; consequently, DHCS implemented additional measures:

- DHCS and the five counties responsible for 85 percent of the discrepant records are in the process of collectively strategizing to develop a path forward in reconciling records.

- DHCS plans to meet with the five counties separately to further discuss the development of a reconciliation process.

- An in-person training session for the five counties was scheduled to address any issues attributing to the creation of new MEDS alerts at the county level, and to provide technical guidance on problematic records.

- DHCS requests counties provide best practices for resolving MEDS alerts for DHCS' review.

- DHCS developed various exercises for counties to perform to gain a better understanding of actions, which contribute to the creation of critical/high volume alerts.

However, in response to the COVID-19 public health emergency, DHCS activated the disaster state plan amendment, which allows counties to focus on application processing and access to care. Currently, Centers for Medicare and Medicaid Services granted DHCS authority to delay the processing of Medi-Cal redeterminations and allow beneficiaries to remain enrolled in the Medi-Cal program (with limited restrictions) regardless of any change in circumstance. DHCS has temporarily suspended the above efforts to allow counties the flexibility to modify business operations to ensure safety of staff and effectively meet the increase in community needs. DHCS will resume all efforts upon termination of the COVID-19 public health emergency.

California State Auditor's Assessment of Status: Pending

Per the department's response, it will not fully implement this recommendation until December 2022.

Response is unchanged. DHCS continues to work with counties to resolve all records identified as discrepant. To expedite the process, in collaboration with the Statewide Automated Welfare System, DHCS performed an automated match process between the MEDS and the Statewide Automated Welfare System to reconcile beneficiary status in both systems. While effective, the effort remains labor intensive and protracted; consequently, DHCS implemented additional measures:

- DHCS and the five counties responsible for 85 percent of the discrepant records are in the process of collectively strategizing to develop a path forward in reconciling records.

- DHCS plans to meet with the five counties separately to further discuss the development of a reconciliation process.

- An in-person training session for the five counties was scheduled to address any issues attributing to the creation of new MEDS alerts at the county level, and to provide technical guidance on problematic records.

- DHCS requests counties provide best practices for resolving MEDS alerts for DHCS' review.

- DHCS developed various exercises for counties to perform to gain a better understanding of actions, which contribute to the creation of critical/high volume alerts.

However, in response to the COVID-19 public health emergency, DHCS activated the disaster state plan amendment, which allows counties to focus on application processing and access to care. Currently, Centers for Medicare and Medicaid Services granted DHCS authority to delay the processing of Medi-Cal redeterminations and allow beneficiaries to remain enrolled in the Medi-Cal program (with limited restrictions) regardless of any change in circumstance. DHCS has temporarily suspended the above efforts to allow counties the flexibility to modify business operations to ensure safety of staff and effectively meet the increase in community needs. DHCS will resume all efforts upon termination of the COVID-19 public health emergency.

California State Auditor's Assessment of Status: Pending

Per the department's response, it will not fully implement this recommendation until December 2022.

Response is unchanged. DHCS continues to work with counties to resolve all records identified as discrepant. To expedite the process, in collaboration with the Statewide Automated Welfare System, DHCS performed an automated match process between the MEDS and the Statewide Automated Welfare System to reconcile beneficiary status in both systems. While effective, the effort remains labor intensive and protracted; consequently, DHCS implemented additional measures:

- DHCS and the five counties responsible for 85 percent of the discrepant records are in the process of collectively strategizing to develop a path forward in reconciling records.

- DHCS plans to meet with the five counties separately to further discuss the development of a reconciliation process

- An in-person training session for the five counties was scheduled to address any issues attributing to the creation of new MEDS alerts at the county level, and to provide technical guidance on problematic records.

- DHCS requests counties provide best practices for resolving MEDS alerts for DHCS' review.

- DHCS developed various exercises for counties to perform to gain a better understanding of actions, which contribute to the creation of critical/high volume alerts.

However, in response to the COVID-19 public health emergency, DHCS activated the disaster state plan amendment, which allows counties to focus on application processing and access to care. Currently, CMS granted DHCS authority to delay the processing of Medi-Cal redeterminations and allow beneficiaries to remain enrolled in the Medi-Cal program (with limited restrictions) regardless of any change in circumstance. DHCS has temporarily suspended the above efforts to allow counties the flexibility to modify business operations to ensure safety of staff and effectively meet the increase in community needs. DHCS will resume all efforts upon termination of the COVID-19 public health emergency.

California State Auditor's Assessment of Status: Pending

Per the department's response, it will not fully implement this recommendation until December 2022.

Response is unchanged. DHCS continues to work with counties to resolve all records identified as discrepant. To expedite the process, in collaboration with the Statewide Automated Welfare System, DHCS performed an automated match process between the Medi-Cal Eligibility Data System (MEDS) and the Statewide Automated Welfare System to reconcile beneficiary status in both systems. While effective, the effort remains labor intensive and protracted; consequently, DHCS implemented additional measures:

DHCS and the five counties responsible for 85 percent of the discrepant records are in the process of collectively strategizing to develop a path forward in reconciling records.

DHCS plans to meet with the five counties separately to further discuss the development of a reconciliation process.

An in-person training session for the five counties was scheduled to address any issues attributing to the creation of new MEDS alerts at the county level, and to provide technical guidance on problematic records.

DHCS requests counties provide best practices for resolving MEDS alerts for DHCS' review.

DHCS developed various exercises for counties to perform to gain a better understanding of actions which contribute to the creation of critical/high volume alerts.

However, in response to the COVID-19 pandemic, DHCS activated the disaster state plan amendment which allows counties to focus on application processing and access to care. Currently, the Centers for Medicare and Medicaid Services granted DHCS authority to delay the processing of Medi-Cal redeterminations and allow beneficiaries to remain enrolled in the Medi-Cal program (with limited restrictions) regardless of any change in circumstance. DHCS has temporarily suspended the above efforts to allow counties the flexibility to modify business operations to ensure safety of staff and effectively meet the increase in community needs. DHCS will resume all efforts upon termination of the COVID-19 public health emergency.

California State Auditor's Assessment of Status: Pending

DHCS continues to work with counties to resolve all records identified as discrepant. To expedite the process, in collaboration with the Statewide Automated Welfare System, DHCS performed an automated match process between the Medi-Cal Eligibility Data System (MEDS) and the Statewide Automated Welfare System to reconcile beneficiary status in both systems. While effective, the effort remains labor intensive and protracted; consequently, DHCS implemented additional measures:

- DHCS and the five counties responsible for 85 percent of the discrepant records are in the process of collectively strategizing to develop a path forward in reconciling records.

- DHCS plans to meet with the five counties separately to further discuss the development of a reconciliation process.

- An in-person training session for the five counties was scheduled to address any issues attributing to the creation of new MEDS alerts at the county level, and to provide technical guidance on problematic records.

- DHCS requests counties provide best practices for resolving MEDS alerts for DHCS' review.

- DHCS developed various exercises for counties to perform to gain a better understanding of actions which contribute to the creation of critical/high volume alerts.

However, in response to the COVID-19 pandemic, DHCS activated the disaster state plan amendment which allows counties to focus on application processing and access to care. Currently, the Centers for Medicare and Medicaid Services granted DHCS authority to delay the processing of Medi-Cal redeterminations and allow beneficiaries to remain enrolled in the Medi-Cal program (with limited restrictions) regardless of any change in circumstance. DHCS has temporarily suspended the above efforts to allow counties the flexibility to modify business operations to ensure safety of staff and effectively meet the increase in community needs. DHCS will resume all efforts upon termination of the COVID-19 public health emergency.

California State Auditor's Assessment of Status: Pending

DHCS continues to work with counties to resolve all records identified as discrepant. Due to both the volume of records and "manual" effort that is needed to confirm the resolved records, and identify records that are pending resolution, this process is labor intensive and protracted. DHCS remains committed to correcting all records and recovering erroneous payments where allowable. DHCS will be able to provide evidence of progress by end of first quarter 2020.

California State Auditor's Assessment of Status: Pending

According to Health Care Services' response, implementation of this recommendation is still pending.

CSA cited five counties that are responsible for 85 percent of the system discrepancies. The Medi-Cal Eligibility Data System (MEDS) alerts pilot targets these 5 counties plus San Francisco. On August 1, 2019, DHCS sent each county a report that contains alerts that are indicative of a discrepancy between systems. Counties are asked to reduce the backlog alerts by ten percent. DHCS tracks progress by:

1. Refreshing the list on a monthly basis

2. Generating a report that does a comparison of the prior and current lists to

determine:

 The number of alerts resolved.

 The number of ongoing alerts.

 The number of new alerts.

The reduction requirement is met when the total number of alerts on the current list and the new alerts is ten percent lower than the previous list. DHCS will work with counties to develop and implement processes to ensure the requirement is met.

DHCS implemented an "Aid Code Clean-up" effort in November 2018. DHCS carefully monitors counties' progress and emails counties "progress reports" when sufficient progress is not demonstrated. Counties are required to provide a response that demonstrates how the county plans to increase the reduction rate. This effort targets aid codes that are most prone to causing discrepancies between systems.

On August 19, 2019, DHCS provided documentation to CSA substantiating that the pilot is fully implemented.

California State Auditor's Assessment of Status: Pending

Health Care Services did not provide evidence for us to substantiate its claim that it had fully implemented the recommendation.

DHCS is currently working with counties to resolve these records. DHCS will send counties an updated list of records that continue to be discrepant on a monthly basis, and will ensure that counties are making satisfactory progress by comparing the previous list to the current list, and calculating the number of records resolved each month. DHCS will increase oversight activities for counties that do not demonstrate sufficient progress by June 30, 2019.

California State Auditor's Assessment of Status: Partially Implemented

Health Care Services provided evidence that it is in the process of implementing a pilot program that aims to reduce backlogged alerts. However, Health Care Services' pilot program is only being implemented at a selection of counties and it will not yet address all of the discrepancies we identified in our report. In addition, the evidence that Health Care Services provided does not indicate what progress, if any, it has made in recovering erroneous payments.

DHCS is currently working with counties to resolve these records. DHCS will send counties an updated list of records that continue to be discrepant on a monthly basis, and will ensure that counties are making satisfactory progress by comparing the previous list to the current list, and calculating the number of records resolved each month. DHCS will increase oversight activities for counties that do not demonstrate sufficient progress by June 30, 2019.

California State Auditor's Assessment of Status: Pending

As of November 2018, DHCS implemented a monitoring process that is expected to assist in resolving the system discrepancies identified in this audit. In January 2019, DHCS will run these records against Medi-Cal Eligibility Data System (MEDS) to ensure that there is a sufficient decrease in the number of discrepant records, and implement any modifications as needed. The outcome of this run will assist DHCS in providing an estimated implementation date; at this point, this date is unknown. Due to the volume of records, DHCS cannot commit to resolving all discrepancies and recovering associated erroneous payments by June 2019, but does commit to demonstrating reasonable progress by this date.

California State Auditor's Assessment of Status: Pending

Recommendation #3 To: Health Care Services, Department of

To prevent future erroneous payments, Health Care Services should implement procedures by December 31, 2018, to ensure the timely resolution of system discrepancies. These procedures should include Health Care Services regularly following up on recurring, unresolved system discrepancies with the responsible county.

DHCS will resume all previously enacted MEDS alerts monitoring efforts including the MEDS Alert Pilot, in June 2024 when the Continuous Coverage Unwinding Period ends.

California State Auditor's Assessment of Status: Pending

DHCS does not expect to fully implement this recommendation until June 2024.

Beginning February 1, 2020, DHCS began monitoring the MEDS alerts reports for all 58 counties. DHCS identified six additional counties to incorporate in a second pilot. DHCS planned to initiate the second pilot in April 2020. Due to the COVID-19 public health emergency, efforts are now suspended.

Please refer to the following documents for further information:

- Request for Section 1135 Waiver Flexibilities Related to COVID-19 Emergency

- Medi-Cal Eligibility Division Information Letter No. I20-07

- Request for Federal Waiver to Cover Medi-Cal Recipients and Expand Tele-Health Options

- California Executive Order N-29-20

Otherwise, no changes from the 48 Month update submitted to CSA on August 4, 2022.

California State Auditor's Assessment of Status: Pending

Per Health Care Services' response, it will not fully implement this recommendation until March 2024.

The estimated implementation date was extended by four months to 3/1/2024, due to an extension of the Federal PHE for COVID-19. No changes from 45-Month Program Update.

California State Auditor's Assessment of Status: Pending

Per Health Care Services' response, it will not implement this recommendation until March 2024.

The Estimated Implementation Date was extended by four months due to an extension of the Federal PHE for COVID-19. Otherwise, no change from previous response.

Beginning February 1, 2020, DHCS began monitoring the MEDS alerts reports for all 58 counties. DHCS identified six additional counties to incorporate in a second pilot. DHCS planned to initiate the second pilot in April 2020. Due to the COVID-19 PHE, efforts are now suspended.

Please refer to the following documents submitted with 39-Month Update in January 2022 for further information:

- Request for Section 1135 Waiver Flexibilities Related to COVID-19 Emergency (Attachment 5).

- MCED Information Letter No. I20-07 (Attachment 6).

- California Requests Federal Government Waiver to Cover Medi-Cal Recipients and Expand Tele-Health Options (Attachment 7).

- California Executive Order N-29-20 (Attachment 8).

California State Auditor's Assessment of Status: Pending

Per Health Care Services' response, it will not fully implement this recommendation until November 2023.

DHCS plans to move forward with the implementation plan provided in the previous update upon termination of the federal public health emergency with no modifications to the original plan: Beginning February 1, 2020, DHCS began monitoring the MEDS alerts reports for all 58 counties. DHCS identified six additional counties to incorporate in a second pilot. DHCS planned to initiate the second pilot in April 2020. Due to the COVID-19 public health emergency, efforts are now suspended.

Please refer to the following documents submitted with 39-Month Update in January 2022 for further information:

-Request for Section 1135 Waiver Flexibilities Related to COVID-19 Emergency (Attachment 5).

-MCED Information Letter No. I20-07 (Attachment 6).

-California Requests Federal Government Waiver to Cover Medi-Cal Recipients and Expand Tele-Health Options (Attachment 7).

-California Executive Order N-29-20 (Attachment 8).

California State Auditor's Assessment of Status: Pending

Per Health Care Services' response, it will not fully implement this recommendation until July 2023.

Response is unchanged from the 36-Month update: Beginning February 1, 2020, DHCS began monitoring the MEDS alerts reports for all 58 counties. DHCS identified six additional counties to incorporate in a second pilot. DHCS planned to initiate the second pilot in April 2020. Due to the COVID-19 public health emergency, efforts are now suspended.

Please refer to the following documents for further information:

- Request for Section 1135 Waiver Flexibilities Related to COVID-19 Emergency

- Medi-Cal Eligibility Division Information Letter No. I20-07

- California Requests Federal Government Waiver to Cover Medi-Cal Recipients and Expand Tele-Health Options

- California Executive Order N-29-20

California State Auditor's Assessment of Status: Pending

Per Health Care Services' response, it will not fully implement this recommendation until December 2022.

Response is unchanged from 33-Month Update. Beginning February 1, 2020, DHCS began monitoring the MEDS alerts reports for all 58 counties. DHCS identified six additional counties to incorporate in a second pilot. DHCS planned to initiate the second pilot in April 2020. Due to the COVID-19 public health emergency, efforts are now suspended.

Please refer to the following documents for further information:

- Request for Section 1135 Waiver Flexibilities Related to COVID-19 Emergency

- Medi-Cal Eligibility Division Information Letter No. I20-07

- California Requests Federal Government Waiver to Cover Medi-Cal Recipients and Expand Tele-Health Options

- California Executive Order N-29-20

California State Auditor's Assessment of Status: Pending

Per Health Care Services' response, it will not fully implement this recommendation until December 2022.

Response is unchanged from 30-Month Update. Beginning February 1, 2020, DHCS began monitoring the MEDS alerts reports for all 58 counties. DHCS identified six additional counties to incorporate in a second pilot. DHCS planned to initiate the second pilot in April 2020. Due to the COVID-19 public health emergency, efforts are now suspended.

Please refer to the following documents for further information:

- Rec 3 - MEDIL No. I 20-07 (Attachment 2)

- Rec 3 - Executive Order N-29-20 (Attachment 1)

California State Auditor's Assessment of Status: Pending

Per the department's response, it will not fully implement this recommendation until December 2022.

Response is unchanged from 27-Month Update. Beginning February 1, 2020, DHCS began monitoring the MEDS alerts reports for all 58 counties. DHCS identified six additional counties to incorporate in a second pilot. DHCS planned to initiate the second pilot in April 2020. Due to the COVID-19 public health emergency, efforts are now suspended.

Please refer to the following documents for further information:

- Request for Section 1135 Waiver Flexibilities Related to COVID-19 Emergency

- Medi-Cal Eligibility Division Information Letter No. I20-07

- California Requests Federal Government Waiver to Cover Medi-Cal Recipients and Expand Tele-Health Options

- California Executive Order N-29-20

California State Auditor's Assessment of Status: Pending

Per the department's response, it will not fully implement this recommendation until December 2022.

Response is unchanged. Beginning February 1, 2020, DHCS began monitoring the MEDS alerts reports for all 58 counties. DHCS identified six additional counties to incorporate in a second pilot. DHCS planned to initiate the second pilot in April 2020. Due to the COVID-19 pandemic, efforts are now suspended.

Please refer to the attachments below for further information:

- Request for Section 1135 Waiver Flexibilities Related to COVID-19 Emergency

- Medi-Cal Eligibility Division Information Letter No. I20-07

- California Requests Federal Government Waiver to Cover Medi-Cal Recipients and Expand Tele-Health Options

- California Executive Order N-29-20

California State Auditor's Assessment of Status: Pending

Per the department's response, it will not fully implement this recommendation until December 2022.

Response is unchanged. Beginning February 1, 2020, DHCS began monitoring the MEDS alerts reports for all 58 counties. DHCS identified six additional counties to incorporate in a second pilot. DHCS planned to initiate the second pilot in April 2020. Due to the COVID-19 public health emergency, efforts are now suspended.

Please refer to the attachments below for further information:

- Request for Section 1135 Waiver Flexibilities Related to COVID-19 Emergency

- Medi-Cal Eligibility Division Information Letter No. I20-07

- California Requests Federal Government Waiver to Cover Medi-Cal Recipients and Expand Tele-Health Options

- California Executive Order N-29-20

California State Auditor's Assessment of Status: Pending

Per the department's response, it will not fully implement this recommendation until December 2022.

Response is unchanged. Beginning February 1, 2020, DHCS began monitoring the MEDS alerts reports for all 58 counties. DHCS identified six additional counties to incorporate in a second pilot. DHCS planned to initiate the second pilot in April 2020. Due to the COVID-19 public health emergency, efforts are now suspended.

Please refer to the attachments below for further information:

- Request for Section 1135 Waiver Flexibilities Related to COVID-19 Emergency

- Medi-Cal Eligibility Division Information Letter No. I20-07

- California Requests Federal Government Waiver to Cover Medi-Cal Recipients and Expand Tele-Health Options

- California Executive Order N-29-20

California State Auditor's Assessment of Status: Pending

Beginning February 1, 2020, DHCS began monitoring the MEDS alerts reports for all 58 counties. DHCS identified six additional counties to incorporate in a second pilot. DHCS planned to initiate the second pilot in April 2020. Due to the COVID-19 public health emergency, efforts are now suspended.

Please refer to the attachments below for further information:

- Request for Section 1135 Waiver Flexibilities Related to COVID-19 Emergency

- Medi-Cal Eligibility Division Information Letter No. I20-07

- California Requests Federal Government Waiver to Cover Medi-Cal Recipients and Expand Tele-Health Options

- California Executive Order N-29-20

California State Auditor's Assessment of Status: Pending

Currently, DHCS' pilot targets the five counties that CSA identified as having the highest number of discrepant records (a total of 85%), and one additional county, San Francisco. Since the pilot contains few counties, communication with a smaller group has proven to be successful in identifying factors that contribute to discrepancies between systems, and facilitating effective solutions to increase synchronization. However, beginning February 1, 2020, DHCS will monitor reports of all 58 counties, and begin the process of working with "high/moderate" risk counties, prior to rolling out the pilot statewide.

California State Auditor's Assessment of Status: Pending

According to Health Care Services' response, implementation of this recommendation is still pending.

DHCS implemented the pilot on June 25, 2019, and submitted substantiating documentation to CSA on August 19, 2019.

California State Auditor's Assessment of Status: Pending

Health Care Services did not provide sufficient evidence for us to substantiate its claim that it had fully implemented the recommendation.

In July 2019, DHCS will implement the MEDS alerts pilot project that was originally scheduled for implementation on May 31, 2019.

DHCS delayed the implementation of the MEDS alerts pilot project to ensure that the reports used for this effort:

- Captured the correct alerts.

- Are formatted to ensure readability.

- Have sort/filter functionalities.

- May be used by DHCS to monitor counties' progress, by developing a secondary report that tracks the number of resolved alerts, ongoing (unresolved) alerts, and the number of new alerts on a monthly basis.

A meeting to discuss the pilot process with the counties is scheduled for June 25, 2019

California State Auditor's Assessment of Status: Partially Implemented

In August 2019 Health Care Services provided evidence that it is in the process of implementing a pilot program that aims to reduce backlogged alerts. However, Health Care Services' pilot program is only being implemented at a selection of counties.

In November 2018, DHCS implemented a quality control process to assist with identifying systems discrepancies. This process includes sending each county a list of individuals in active transitional aid codes that are active in MEDS only. DHCS is monitoring counties' progress in resolving the discrepancies on a regular basis to assess progress in reducing the number of system discrepancies for this population between the state and county systems. In May 2019, DHCS will deploy a second quality control process that specifically focuses on MEDS alerts generated due to a discrepancy in eligibility status between SAWS and MEDS. DHCS will assess progress to evaluate the extent to which the number of alerts are decreasing at a steady, reasonable rate.

California State Auditor's Assessment of Status: Partially Implemented

As of November 2018, DHCS implemented a quality control process to assist with identifying systems discrepancies. This process includes sending each county a list of individuals in active transitional aid codes that are active in MEDS only. DHCS will monitor counties' progress in resolving the discrepancies on a regular basis to assess progress in reducing the number of system discrepancies for this population between the state and county systems.

In January 2019, DHCS will deploy a second quality control process that specifically focuses on MEDS alerts generated due to a discrepancy in eligibility status between the Statewide Automated Welfare System and MEDS. DHCS will assess progress to evaluate the extent to which the number of alerts are decreasing at a steady, reasonable rate.

California State Auditor's Assessment of Status: Partially Implemented

Recommendation #4 To: Health Care Services, Department of

To prevent future erroneous payments, Health Care Services should establish procedures by December 31, 2018, that define when it will use its authority as defined in state law to sanction unresponsive counties that do not remedy known discrepancies.

The California Advancing and Innovating Medi-Cal Proposal (CalAIM), released by DHCS on January 8, 2021, proposes to implement Enhanced County Eligibility Oversight and Monitoring Activities, which include establishing procedures defining when DHCS will use authority to sanction unresponsive counties not remedying known discrepancies. DHCS will resume county oversight activities on June 1, 2024, when the Continuous Coverage Unwinding Period ends.

California State Auditor's Assessment of Status: Pending

DHCS does not expect to fully implement this recommendation until June 2024.

The revised California Advancing and Innovating Medi-Cal Proposal (CalAIM), released by DHCS on January 8, 2021, proposes to implement Enhanced County Eligibility Oversight and Monitoring Activities, which include establishing procedures defining when DHCS will use authority to sanction unresponsive counties not remedying known discrepancies. Due to the COVID-19 pandemic, efforts are now suspended. Please refer to the response to Recommendation 3, referencing DHCS' response to the COVID-19 pandemic, and the attachment below:

the CalAIM Proposal

Otherwise, no changes from the 48 Month update submitted to CSA on August 4, 2022.

California State Auditor's Assessment of Status: Pending

Per Health Care Services' response, it will not fully implement this recommendation until March 2024.

The estimated implementation date was extended by four months to 3/1/2024, due to an extension of the PHE for COVID-19. No changes from 45-Month Program Update.

California State Auditor's Assessment of Status: Pending

Per Health Care Services' response, it will not implement this recommendation until March 2024.

The Estimated Implementation Date was extended by four months due to an extension of the PHE for COVID-19. Otherwise, no change from previous response:

The revised "California Advancing and Innovating Medi-Cal Proposal" released by DHCS on January 8, 2021, proposes to implement Enhanced County Eligibility Oversight and Monitoring Activities which include establishing procedures defining when DHCS will use authority to sanction unresponsive counties not remedying known discrepancies. Due to the COVID-19 pandemic, efforts are now suspended. Please refer to the response to Recommendation 3 referencing DHCS' response to the COVID-19 pandemic, and on pages 102-14 in the attachment below:

"California Advancing and Innovating Medi-Cal Proposal" (Attachment 9): https://www.dhcs.ca.gov/provgovpart/Documents/CalAIM-Proposal-Updated-1-8-21.pdf.

California State Auditor's Assessment of Status: Pending

Per Health Care Services' response, it will not fully implement this recommendation until November 2023.

DHCS plans to move forward with the implementation plan provided in the previous update upon termination of the public health emergency with no modifications to the original plan. Response is unchanged from 39-Month Update: The revised "California Advancing and Innovating Medi-Cal Proposal" released by DHCS on January 8, 2021, proposes to implement Enhanced County Eligibility Oversight and Monitoring Activities which include establishing procedures defining when DHCS will use authority to sanction unresponsive counties not remedying known discrepancies. Due to the COVID-19 pandemic, efforts are now suspended. Please refer to the response to Recommendation 3 referencing DHCS' response to the COVID-19 pandemic, and on pages 102-14 in the attachment below:

"California Advancing and Innovating Medi-Cal Proposal" (Attachment 9): https://www.dhcs.ca.gov/provgovpart/Documents/CalAIM-Proposal-Updated-1-8-21.pdf

California State Auditor's Assessment of Status: Pending

Per Health Care Services' response, it will not fully implement this recommendation until July 2023.

Response is unchanged from the 36-Month update: The revised California Advancing and Innovating Medi-Cal Proposal released by DHCS on January 8, 2021, proposes to implement Enhanced County Eligibility Oversight and Monitoring Activities which include establishing procedures defining when DHCS will use authority to sanction unresponsive counties not remedying known discrepancies. Due to the COVID-19 pandemic, efforts are now suspended. Please refer to the response to Recommendation 3 referencing DHCS' response to the COVID-19 pandemic, and the attachment below:

California Advancing and Innovating Medi-Cal Proposal

California State Auditor's Assessment of Status: Pending

Per Health Care Services' response, it will not fully implement this recommendation until June 2022.

Response is unchanged from 33-Month Update. The revised California Advancing and Innovating Medi-Cal Proposal released by DHCS on January 8, 2021, proposes to implement Enhanced County Eligibility Oversight and Monitoring Activities which include establishing procedures defining when DHCS will use authority to sanction unresponsive counties not remedying known discrepancies. Due to the COVID-19 pandemic, efforts are now suspended. Please refer to the response to Recommendation 3 referencing DHCS' response to the COVID-19 pandemic, and the attachment below:

California Advancing and Innovating Medi-Cal Proposal

California State Auditor's Assessment of Status: Pending

Per Health Care Services' response, it will not fully implement this recommendation until June 2022.

The revised California Advancing and Innovating Medi-Cal Proposal released by DHCS on January 8, 2021, proposes to implement Enhanced County Eligibility Oversight and Monitoring Activities, which include establishing procedures defining when DHCS will use authority to sanction unresponsive counties not remedying known discrepancies. Due to the COVID-19 pandemic, efforts are now suspended. Please refer to the response to Recommendation 3 referencing DHCS' response to the COVID-19 pandemic, and see Rec 4 - CalAIM Proposal - January 2021 (Attachment 3).

California State Auditor's Assessment of Status: Pending

Per the department's response, it will not fully implement this recommendation until June 2022.

Response is unchanged from 27-Month Update. The California Advancing and Innovating Medi-Cal Proposal released by DHCS on October 29, 2019, proposes to implement Enhanced County Eligibility Oversight and Monitoring Activities which include establishing procedures defining when DHCS will use authority to sanction unresponsive counties not remedying known discrepancies. Due to the COVID-19 pandemic, efforts are now suspended. Please refer to the response to Recommendation 3 referencing DHCS' response to the COVID-19 pandemic, and the attachment below:

- California Advancing and Innovating Medi-Cal Proposal

California State Auditor's Assessment of Status: Pending

Per the department's response, it will not fully implement this recommendation until June 2022.

Response is unchanged. The California Advancing and Innovating Medi-Cal Proposal released by DHCS on October 29, 2019, proposes to implement Enhanced County Eligibility Oversight and Monitoring Activities which include establishing procedures defining when DHCS will use authority to sanction unresponsive counties not remedying known discrepancies. Due to the COVID-19 pandemic, efforts are now suspended. Please refer to the response to recommendation three referencing DHCS' response to the COVID-19 pandemic, and the attachment below:

- California Advancing and Innovating Medi-Cal Proposal

California State Auditor's Assessment of Status: Pending

Per the department's response, it will not fully implement this recommendation until June 2022.

Response is unchanged. The California Advancing and Innovating Medi-Cal Proposal released by DHCS on October 29, 2019, proposes to implement Enhanced County Eligibility Oversight and Monitoring Activities which include establishing procedures defining when DHCS will use authority to sanction unresponsive counties not remedying known discrepancies. Due to the COVID-19 public health emergency, efforts are now suspended. Please refer to the response to recommendation three referencing DHCS' response to the COVID-19 public health emergency, and the attachment below:

- California Advancing and Innovating Medi-Cal Proposal

California State Auditor's Assessment of Status: Pending

Per the department's response, it will not fully implement this recommendation until June 2022.

Response is unchanged. The California Advancing and Innovating Medi-Cal Proposal released by DHCS on October 29, 2019, proposes to implement Enhanced County Eligibility Oversight and Monitoring Activities which include establishing procedures defining when DHCS will use authority to sanction unresponsive counties not remedying known discrepancies. Due to the COVID-19 public health emergency, efforts are now suspended. Please refer to the response to recommendation three referencing DHCS' response to the COVID-19 pandemic, and the attachment below:

- California Advancing and Innovating Medi-Cal Proposal

California State Auditor's Assessment of Status: Pending

The California Advancing and Innovating Medi-Cal Proposal released by DHCS on October 29, 2019, proposes to implement Enhanced County Eligibility Oversight and Monitoring Activities which include establishing procedures defining when DHCS will use authority to sanction unresponsive counties not remedying known discrepancies. Due to the COVID-19 public health emergency, efforts are now suspended. Please refer to the response to recommendation three referencing DHCS' response to the COVID-19 pandemic, and the attachment below:

- California Advancing and Innovating Medi-Cal Proposal

California State Auditor's Assessment of Status: Pending

DHCS will implement a holistic "Assessment and Expectations in the Administration of the Medi-Cal Program" policy, which will include the development of county performance standards expectations. DHCS will work with county partners to establish a tiered corrective action approach to:

- Ensure that DHCS provides technical assistance to counties upon request.

- Identify, address, and correct error trends found through the course of external and internal reviews.

- Impose a corrective action requirement for counties that do not meet performance expectations.

It is anticipated that utilizing this approach will allow the department the opportunity to:

- Isolate areas where additional oversight is required.

- Work collaboratively with stakeholders to correct deficiencies in the administration of the program.

- Develop a fair, and effective progressive disciplinary approach to leverage when, and if, necessary.

The proposed timeline for implementing this policy is outlined in the attachment.

California State Auditor's Assessment of Status: Pending

According to Health Care Services' response, implementation of this recommendation is still pending.

DHCS will implement a holistic "Assessment and Expectations in the Administration of the Medi-Cal Program" policy, which will include the development of county performance standards expectations. DHCS will work with county partners to establish a tiered Corrective Action approach to: ensure that DHCS provides technical assistance to counties upon request, identify, address and correct error trends found through the course of external and internal reviews, and impose a corrective action requirement for counties that do not meet performance expectations. It is anticipated that utilizing this approach will allow the Department the opportunity to isolate areas where additional oversight is required, work collaboratively with stakeholders to correct deficiencies in the administration of the program, and develop a fair, and effective progressive disciplinary approach to leverage when, and if, necessary. The proposed timeline for implementing this policy is outlined in the attachment.

California State Auditor's Assessment of Status: Pending

Per Health Care Services' response, implementation of this recommendation is pending.

DHCS is in the process of issuing a Medi-Cal Eligibility Division (MCED) Information Letter that notifies counties of the reinstatement of self-certification of performance standards. It should be noted that since this effort requires communications with stakeholder outside of DHCS, and due to other work efforts associated with other recommendations for this audit, the anticipated date of completion is now August 31, 2019.

California State Auditor's Assessment of Status: Pending

According to Health Care Services' response, implementation of this recommendation is still pending.

DHCS is in the process of issuing a Medi-Cal Eligibility Division (MCED) Information Letter that notifies counties of the reinstatement of self-certification of performance standards. It should be noted that since this effort requires communications with stakeholder outside of DHCS, and due to other work efforts associated with other recommendations for this audit, the anticipated date of completion is now August 31, 2019.

California State Auditor's Assessment of Status: Pending

DHCS is in the process of scheduling meetings with counties to clarify the department's expectations of overall performance. Upon completion of these meetings, DHCS will develop metrics to measure performance and accountability, and administrative procedures to address performance issues. DHCS is on target to establish these procedures by July 1, 2019.

California State Auditor's Assessment of Status: Pending

Recommendation #5 To: Health Care Services, Department of

To assist counties in addressing discrepancies, Health Care Services should find a cost-effective method to provide its exception reports in an electronic format readable by common database and spreadsheet software products that would allow users to sort and filter the data readily by December 31, 2018.

As per the CSA's recommendation to make the reports accessible to counties in an electronic format, the electronic version of the EER reports are now delivered to the respective counties' MoveIT folders where the counties can access the reports to query as needed. Changes were implemented in three phases.

Phase I - Implementation to deliver electronic version of the formatted EER's to the counties via secured file transfer (MoveIT) was completed on December 31, 2018. All California counties now receive the electronic version of the formatted EER report (as is version) via MoveIT server.

Phase II - Implementation of changes to ensure the electronic version of the EER data is available to all California counties in a readable format was completed on June 12, 2019. Counties can now search and query the downloaded EER data in the excel spreadsheet.

Phase III - Changes to generate the electronic version of Burman reports, IEVS reports, and SAVES reports was implemented by November 8, 2019.

California State Auditor's Assessment of Status: Fully Implemented

Health Care Services provided screenshots showing that it has made electronic copies of its Burman reports, Income and Eligibility Verification System (IEVS) reports, and Systematic Alien Verification and Eligibility System (SAVES) reports, and other Medi-Cal Eligibility Data System (MEDS) alert reports available to the counties. In addition, Health Care Services provided an example of an electronic report, along with instructions that counties can follow to make the data ready for sorting and filtering.

The Burman reports, Income and Eligibility Verification System (IEVS) reports, and Systematic Alien Verification and Eligibility System (SAVES) reports were brought to our attention after the previous implementation of EER reports that were completed on June 12, 2019.

Changes to generate the electronic version of Burman reports, IEVS reports, and SAVES reports were coded, tested, and ready to implement. Some components of the Burman reports are already implemented and the reports are delivered to respective counties. The remainder of these reports are pending Data Release approvals which are underway. Due to the time required to Quality Assurance check these additional twelve reports for the 58 counties, we expect to have them all implemented in the month of November 2019.

California State Auditor's Assessment of Status: Pending

Per Health Care Services' response, implementation of this recommendation is pending.

Implementation of changes to ensure that the electronic version of the EER data is available to all California counties in a readable format was completed on Wednesday, June 12, 2019. EER data files are securely uploaded to the respective county folders in the MoveIT secure file transfer server and the instructions to download the EER data into a spreadsheet was provided to all California counties. Counties will be able to search and query the downloaded EER data in the spreadsheet.

California State Auditor's Assessment of Status: Partially Implemented

Health Care Services provided evidence that it has provided counties with exception reports for its EER data in an electronic format. However, Health Care Services noted that it is still in the process of implementing the recommendation for its other exception reports, including the Burman reports, Income and Eligibility Verification System (IEVS) reports, and Systematic Alien Verification and Eligibility System (SAVES) reports.

Phase I - Implementation of changes to deliver electronic version of the formatted EER's to the counties via secured file transfer (via MoveIT) was completed on December 31, 2018. All California counties now receive the electronic version of the formatted EER report via MoveIT server.

Phase II - DHCS will ensure that the electronic version of the EER data is available to all California counties in a readable format. Counties will be able to search and query on this data via common software products. DHCS is coordinating this work effort with counties to ensure that the counties are able to utilize the EER data file by June 30, 2019 the target implementation date.

California State Auditor's Assessment of Status: Partially Implemented

Though DHCS fully agrees with the findings, the recommendation is not feasible to implement by

December 31, 2018.

DHCS has completed the preliminary research and documented the proposed implementation approach below.

DHCS will implement the recommendation with a target phased completion by June 30, 2019, as detailed below.

Phase I

DHCS will deliver the electronic version of the formatted EER's to the counties via secured file transfer to eTransfer server (MoveIT). This migration of counties to MoveIT addresses counties that are currently not receiving the electronic version of the EER.

Planned Implementation Date: December 31, 2018

Phase II

DHCS will deliver the electronic version of the EER data, via secured file transfer to MoveIT in a format which is consumable by spreadsheet software products. This will allow all counties to sort and filter the data readily.

Planned Implementation Date: June 30, 2019

California State Auditor's Assessment of Status: Pending

Recommendation #6 To: Health Care Services, Department of

To assist counties in addressing discrepancies, Health Care Services should reevaluate and update its guidance to the counties related to prioritizing MEDS alerts by December 31, 2018.

In preparation for the resumption of county oversight monitoring activities in June 2024, DHCS published All County Welfare Department Letter 23-14 in July 2023. The letter informs counties of the prioritization of MEDS Alerts based on the impact to eligibility.

California State Auditor's Assessment of Status: Fully Implemented

DHCS issued updated guidance in July 2023 related to processing MEDS alerts.

DHCS is working with the pilot counties to identify caseworker actions resulting in specific, high-volume alerts. DHCS works collaboratively with the pilot counties to develop and implement business practices to reduce the overall number of alerts produced on a monthly basis, and leverage pilot activities to identify MEDS alerts most effective in:

- Reducing discrepancies between systems.

- Capturing records in a hold status for an extended period.

- Capturing records no longer meeting eligibility criteria for the assigned aid code.

DHCS' pilot activities will assist in developing updated guidance to prioritize MEDS alerts and provide guidance on actions counties may take to reduce the creation of MEDS alerts.

Due to the COVID-19 public health emergency, efforts are now suspended. Please refer to the response to Recommendation 3 referencing DHCS' response to the COVID-19 pandemic.

Otherwise, no changes from the 48 Month update submitted to CSA on August 4, 2022.

California State Auditor's Assessment of Status: Pending

Per Health Care Services' response, it will not fully implement this recommendation until March 2024.

The estimated implementation date was extended by four months to 3/1/2024, due to an extension of the PHE for COVID-19. No changes from 45-Month Program Update.

California State Auditor's Assessment of Status: Pending

Per Health Care Services' response, it will not implement this recommendation until March 2024.

The Estimated Implementation Date was extended by four months due to an extension of the PHE for COVID-19. Otherwise, no change from previous response:

DHCS is working with the pilot counties to identify caseworker actions resulting in specific, high volume alerts. DHCS works collaboratively with the pilot counties to develop and implement business practices to reduce the overall number of alerts produced on a monthly basis, and leverage pilot activities to identify MEDS alerts most effective in:

- Reducing discrepancies between systems.

- Capturing records in a hold status for an extended period.

- Capturing records no longer meeting eligibility criteria for the assigned aid code.

DHCS' pilot activities will assist in developing updated guidance to prioritize MEDS alerts and provide guidance on actions counties may take to reduce the creation of MEDS alerts.

Due to the COVID-19 PHE, efforts are now suspended. Please refer to the response to Recommendation 3 referencing DHCS' response to the COVID-19 pandemic.

California State Auditor's Assessment of Status: Pending

Per Health Care Services' response, it will not fully implement this recommendation until November 2023.

DHCS plans to move forward with the implementation plan provided in the previous update upon termination of the public health emergency with no modifications to the original plan. Response is unchanged from 39-Month Update. DHCS is working with the pilot counties to identify caseworker actions resulting in specific, high volume alerts. DHCS works collaboratively with the pilot counties to develop and implement business practices to reduce the overall number of alerts produced on a monthly basis, and leverage pilot activities to identify MEDS alerts most effective in:

-Reducing discrepancies between systems.

-Capturing records in a hold status for an extended period.

-Capturing records no longer meeting eligibility criteria for the assigned aid code.

DHCS' pilot activities will assist in developing updated guidance to prioritize MEDS alerts and provide guidance on actions counties may take to reduce the creation of MEDS alerts.

Due to the COVID-19 public health emergency, efforts are now suspended. Please refer to the response to Recommendation 3 referencing DHCS' response to the COVID-19 pandemic.

California State Auditor's Assessment of Status: Pending

Per Health Care Services' response, it will not fully implement this recommendation until July 2023.

Response is unchanged from the 36-Month update. DHCS is working with the pilot counties to identify caseworker actions resulting in specific, high volume alerts. DHCS works collaboratively with the pilot counties to develop and implement business practices to reduce the overall number of alerts produced on a monthly basis, and leverage pilot activities to identify MEDS alerts most effective in:

- Reducing discrepancies between systems.

- Capturing records in a hold status for an extended period.

- Capturing records no longer meeting eligibility criteria for the assigned aid code.

DHCS' pilot activities will assist in developing updated guidance to prioritize MEDS alerts and provide guidance on actions counties may take to reduce the creation of MEDS alerts.

Due to the COVID-19 public health emergency, efforts are now suspended. Please refer to the response to Recommendation 3 referencing DHCS' response to the COVID-19 pandemic.

However, due to the extension of the original termination date of the federal public health emergency, the estimated implementation date is now 12/31/2022.

California State Auditor's Assessment of Status: Pending

Per Health Care Services' response, it will not fully implement this recommendation until December 2022.

Response is unchanged from 33-Month Update. DHCS is working with the pilot counties to identify caseworker actions resulting in specific, high volume alerts. DHCS works collaboratively with the pilot counties to develop and implement business practices to reduce the overall number of alerts produced on a monthly basis, and leverage pilot activities to identify MEDS alerts most effective in:

- Reducing discrepancies between systems.

- Capturing records in a hold status for an extended period.

- Capturing records no longer meeting eligibility criteria for the assigned aid code.

DHCS' pilot activities will assist in developing updated guidance to prioritize MEDS alerts and provide guidance on actions counties may take to reduce the creation of MEDS alerts.

Due to the COVID-19 public health emergency, efforts are now suspended. Please refer to the response to Recommendation 3 referencing DHCS' response to the COVID-19 pandemic.

However, due to the extension of the original termination date of the federal public health emergency, the estimated implementation date is now 12/31/2022.

California State Auditor's Assessment of Status: Pending

Per Health Care Services' response, it will not fully implement this recommendation until December 2022.

Response is unchanged from 30-Month Update. DHCS is working with the pilot counties to identify caseworker actions resulting in specific, high-volume alerts. DHCS works collaboratively with the pilot counties to develop and implement business practices to reduce the overall number of alerts produced on a monthly basis, and leverage pilot activities to identify MEDS alerts most effective in:

- Reducing discrepancies between systems.

- Capturing records in a hold status for an extended period.

- Capturing records no longer meeting eligibility criteria for the assigned aid code.

DHCS' pilot activities will assist in developing updated guidance to prioritize MEDS alerts and provide guidance on actions counties may take to reduce the creation of MEDS alerts.

Due to the COVID-19 public health emergency, efforts are now suspended. Please refer to the response to Recommendation 3 referencing DHCS' response to the COVID-19 pandemic.

California State Auditor's Assessment of Status: Pending

Per the department's response, it will not fully implement this recommendation until December 2021.

Response is unchanged from 27-Month Update. DHCS is working with the pilot counties to identify caseworker actions resulting in specific, high volume alerts. DHCS works collaboratively with the pilot counties to develop and implement business practices to reduce the overall number of alerts produced on a monthly basis, and leverage pilot activities to identify MEDS alerts most effective in:

- Reducing discrepancies between systems.

- Capturing records in a hold status for an extended period.

- Capturing records no longer meeting eligibility criteria for the assigned aid code.

DHCS' pilot activities will assist in developing updated guidance to prioritize MEDS alerts and provide guidance on actions counties may take to reduce the creation of MEDS alerts.

Due to the COVID-19 public health emergency, efforts are now suspended. Please refer to the response to Recommendation 3 referencing DHCS' response to the COVID-19 pandemic.

California State Auditor's Assessment of Status: Pending

Per the department's response, it will not fully implement this recommendation until December 2021.

Response is unchanged. DHCS is working with the pilot counties to identify caseworker actions resulting in specific, high volume alerts. DHCS works collaboratively with the pilot counties to develop and implement business practices to reduce the overall number of alerts produced on a monthly basis, and leverage pilot activities to identify MEDS alerts most effective in:

- Reducing discrepancies between systems.

- Capturing records in a hold status for an extended period.

- Capturing records no longer meeting eligibility criteria for the assigned aid code.

DHCS' pilot activities will assist in developing updated guidance to prioritize MEDS alerts and provide guidance on actions counties may take to reduce the creation of MEDS alerts.

Due to the COVID-19 public health emergency, efforts are now suspended. Please refer to the response to recommendation three referencing DHCS' response to the COVID-19 pandemic.

California State Auditor's Assessment of Status: Pending

Per the department's response, it will not fully implement this recommendation until June 2021.

Response is unchanged. DHCS is working with the pilot counties to identify caseworker actions resulting in specific, high volume alerts. DHCS works collaboratively with the pilot counties to develop and implement business practices to reduce the overall number of alerts produced on a monthly basis, and leverage pilot activities to identify MEDS alerts most effective in:

- Reducing discrepancies between systems.

- Capturing records in a hold status for an extended period.

- Capturing records no longer meeting eligibility criteria for the assigned aid code.

DHCS' pilot activities will assist in developing updated guidance to prioritize MEDS alerts and provide guidance on actions counties may take to reduce the creation of MEDS alerts.

Due to the COVID-19 public health emergency, efforts are now suspended. Please refer to the response to recommendation three referencing DHCS' response to the COVID-19 public health emergency.

California State Auditor's Assessment of Status: Pending

Per the department's response, it will not fully implement this recommendation until June 2021.

Response is unchanged. DHCS is working with the pilot counties to identify case worker actions resulting in specific, high volume alerts. DHCS works collaboratively with the pilot counties to develop and implement business practices to reduce the overall number of alerts produced on a monthly basis, and leverage pilot activities to identify MEDS alerts most effective in:

- Reducing discrepancies between systems.

- Capturing records in a hold status for an extended period of time.

- Capturing records no longer meeting eligibility criteria for the assigned aid code.

DHCS' pilot activities will assist in developing updated guidance to prioritize MEDS alerts and provide guidance on actions counties may take to reduce the creation of MEDS alerts.

Due to the COVID-19 public health emergency, efforts are now suspended. Please refer to the response to recommendation three referencing DHCS' response to the COVID-19 pandemic.

California State Auditor's Assessment of Status: Pending

DHCS is working with the pilot counties to identify case worker actions resulting in specific, high volume alerts. DHCS works collaboratively with the pilot counties to develop and implement business practices to reduce the overall number of alerts produced on a monthly basis, and leverage pilot activities to identify MEDS alerts most effective in:

- Reducing discrepancies between systems.

- Capturing records in a hold status for an extended period of time.

- Capturing records no longer meeting eligibility criteria for the assigned aid code.

DHCS' pilot activities will assist in developing updated guidance to prioritizes MEDS alerts and provide guidance on actions counties may take to reduce the creation of MEDS alerts.

Due to the COVID-19 public health emergency, efforts are now suspended. Please refer to the response to recommendation three referencing DHCS' response to the COVID-19 pandemic.

California State Auditor's Assessment of Status: Pending

The prioritization of MEDS alerts is a separate effort; however, the pilot will be leveraged to identify MEDS alerts that are most effective in:

- Reducing discrepancies between systems.

- Capturing records that remain in a hold status for an extended period of time.

- Capturing records that no longer meet the eligibility criteria for the assigned aid code.

DHCS will then work with stakeholders to prioritize these alerts. Upon completion of this process, DHCS will issue updated guidance on the prioritization of MEDS alerts.

California State Auditor's Assessment of Status: Pending

According to Health Care Services' response, implementation of this recommendation is still pending.

DHCS will leverage the MEDS alerts pilot to identify the MEDS alerts that are the most effective in:

 Reducing discrepancies between systems.

 Capturing records that remain in a hold status for an extended period of time.

 Capturing records that no longer meet the eligibility criteria for the assigned aid code.

DHCS will then work with stakeholders to prioritize these alerts. Upon completion of this process, DHCS will issue updated guidance on the prioritization of MEDS alerts.

California State Auditor's Assessment of Status: Pending

Although Health Care Services noted that it fully implemented the recommendation in June 2019, its response notes that it has not yet completed this process or issued updated guidance on the prioritization of MEDS alerts.

In July 2019, DHCS will implement the MEDS alerts pilot project that was originally scheduled for implementation on May 31, 2019.

DHCS delayed the implementation of the MEDS alerts pilot project to ensure that the reports used for this effort:

- Captured the correct alerts.

- Are formatted to ensure readability.

- Have sort/filter functionalities.

- May be used by DHCS to monitor counties' progress, by developing a secondary report that tracks the number of resolved alerts, ongoing (unresolved) alerts, and the number of new alerts on a monthly basis.

California State Auditor's Assessment of Status: Pending

According to Health Care Services' response, implementation of this recommendation is still pending.

In May 2019, DHCS will deploy a MEDS alerts pilot program. Part of this pilot includes regularly scheduled meetings between counties and DHCS program and Information Technology staff who specialize in MEDS functionality. DHCS will leverage these meetings to obtain counties' input to develop updated guidance on prioritizing MEDS alerts.

California State Auditor's Assessment of Status: Pending

DHCS is in the initial phase of contacting internal and external partners to engage in discussions that will assist in prioritizing MEDS alerts. DHCS is on target to release updated guidance to counties by April 30, 2019.

California State Auditor's Assessment of Status: Pending

All Recommendations in 2018-603

Agency responses received are posted verbatim.