Report 2020-613 Recommendation 2 Responses
Report 2020-613: Department of Health Care Services: Despite the COVID-19 Public Health Emergency, the Department Can Do More to Address Chronic Medi‑Cal Eligibility Problems (Release Date: July 2021)
Recommendation #2 To: Health Care Services, Department of
To reduce inappropriate payments made to medical providers and ensure eligible individuals' access to care, Health Care Services should, by August 2021, instruct counties to resume processing overdue determinations for individuals who have received temporary eligibility and make a determination on each applicant's Medi-Cal eligibility.
On April 7, 2022, DHCS instructed counties to terminate eligibility for individuals enrolled in an Accelerated Enrollment program and who have failed to provide requested information, as instructed in MEDIL 20-26, Section J. Please see attached agenda, Item Number 11, for confirmation.
- Completion Date: April 2022
California State Auditor's Assessment of Status: Fully Implemented
No later than May 31, 2022, DHCS will instruct counties to terminate eligibility for individuals enrolled in an Accelerated Enrollment program and who have failed to provide requested information, as instructed in MEDIL 20-26, Section J. DHCS will provide such instruction at one of the standing monthly meetings DHCS has with counties.
- Estimated Completion Date: 5/31/2022
California State Auditor's Assessment of Status: Pending
DHCS will communicate with counties through email to process alerts related to presumptive eligibility programs in accordance with MEDIL 20-26 section J.
Link to MEDIL 20-26:
https://www.dhcs.ca.gov/services/medi-cal/eligibility/letters/Documents/I20-26.pdf
Due to changes from the previous implementation plan, additional time is needed to complete the process resulting in an extension of the estimated implementation date to 01/31/22.
- Estimated Completion Date: 01/31/2022
California State Auditor's Assessment of Status: Pending
No change from draft report response. On August 14, 2020, DHCS released MEDIL 20 26 (section J) which notifies counties it is allowable to terminate eligibility for individuals enrolled in an Accelerated Enrollment program who fail to provide requested information.
Link to MEDIL 20-26:
https://www.dhcs.ca.gov/services/medi-cal/eligibility/letters/Documents/I20-26.pdf
- Completion Date: August 2020
California State Auditor's Assessment of Status: Pending
As we note in the report on page 37, rebuttal point 2, Health Care Services' claim that it has already fully implemented our recommendation is not correct. We acknowledge in the report that the department notified counties it is allowable to take action on cases with temporary eligibility. However, we also note that the department instructed counties to suspend processing reports, which include alerts for temporary eligibility.
- Auditee did not substantiate its claim of full implementation
All Recommendations in 2020-613
Agency responses received are posted verbatim.