With the implementation of the Affordable Care Act, eligibility for Medi-Cal has expanded significantly. Now, there are more than 12 million Californians with Medi-Cal benefits and over three-quarters of whom are members of Medi-Cal Managed Care programs. Under Medi-Cal Managed Care, “the state pays insurers a fixed amount per enrollee and expects the plans to provide access to doctors and comprehensive care.” However, a recent state audit report showed California has not ensured that plans provide this necessary access to doctors and care. The audit report found, among other issues, the following failings:
- “Incorrect or missing data on provider networks meant that state health officials had no idea if the plans had sufficient doctors and specialists, or if patients got the care they needed.
- An average of 12,500 calls to the program’s ombudsman went unanswered each month for nearly a year, frustrating patients’ efforts to resolve problems.
- Provider directories for three health plans – Health Net in Los Angeles County, Anthem Blue Cross in Fresno County and Partnership Health Plan of California in Solano County – contained inaccurate or outdated information, ranging from incorrect telephone numbers for providers to listings for providers who no longer participated.”
The effect of these shortcomings has been that people may have insurance cards stating they have Medi-Cal coverage, but they are unable to find a doctor whom they can easily access. The Department of Health Care Services has agreed with many of the auditors findings and says it is already working to make improvements.