State Auditor Releases Report on Preventive Services for Medi-Cal Children

On Thursday, California State Auditor Elaine Howle released a report, “Department of Health Care Services: Millions of Children in Medi-Cal Are Not Receiving Preventive Health Services.” The audit report determined that an average of 2.4 million children in Medi-Cal per year did not receive all required preventive health services between FY 2013-14 and FY 2017-18. The report indicated that California’s utilization rate for preventive services has remained below 50 percent and ranked 40th among all U.S. states. For example, childhood immunization goals, set at 80 percent, have not been met in the past five years with rates ranging from 70 to 75 percent.

Further, the audit report indicated that although DHCS may impose financial sanctions or penalties against Medi-Cal health plans not meeting established performance levels, plans very rarely faced such penalties. According to State Auditor Howle, DHCS has not provided adequate guidance and oversight of Medi-Cal managed care plans, particularly in areas of contract management, follow-up on plan outreach to beneficiaries, and maintenance of accurate provider information.

State Auditor Howle makes a series of recommendations to improve upon the delivery of Medi-Cal preventive services to children. Recommendations suggest the Legislature direct DHCS to ensure plans assist members in locating out-of-network providers when travel times and distances to in-network providers are unreasonable and implement a pay-for-performance program to ensure plans are more consistently delivering preventive services. DHCS is urged establish performance measures for all relevant age groups and require plans to report utilization rates on those measures, modify processes for ensuring health plans and providers adequately deliver preventive services, and ensure plans are effectively mitigating child health disparities related to cultural and linguistic needs.

The full State Auditor report is available here.