Audit Finds Problems With Medi-Cal Managed Care System

The California State Auditor examined how the Department of Health Care Services is monitoring health insurance plans that accept Medi-Cal patients. Of the more than 12 million people enrolled in Medi-Cal, more than 75 percent are enrolled in a health plan.

The audit found the department did not verify data provided by insurers so it cannot verify that the plans provide adequate services for Medi-Cal enrollees.

The audit found that thousands of calls to the Medi-Cal Managed Care Ombudsman last year were either rejected or went unanswered because the telephone system is outdated.

Additionally, the department did not perform medical audits of the health plans as required by statute.

The audit says the Department of Health Care Services largely agrees with the report’s findings and recommendations and will work to implement them.