DHCS expands phone system for Medi-Cal recipients in wake of critical June audit report

October 08, 2015
Area(s) of Interest: Access to Care Practice Management 

In June, the California State Auditor’s office released a report that found the Medi-Cal phone system for beneficiaries to be “severely deficient”; the auditor urged the Department of Health Care Services (DHCS) to make upgrades. The report found that DHCS had an average of 12,500 unanswered called each month, between February 2014 and January 2015. Some months, the telephone system rejected as many as 45,000 calls.

On September 30, 2015, DHCS announced that the ombudsman phone system has been expanded. The new system is expected to improve data collection, reduce the number of dropped calls and allow patients to leave messages. The system will expand phone capacity to handle 500 calls at a time, up from the previous system's 30.

Currently, about 12.2 million Californians—or about one-third of the state’s residents—receive health care coverage through Medi-Cal. That number has spiked since Medi-Cal eligibility was expanded under the Affordable Care Act.

Among other key findings of the June audit were that the fact that DHCS “has not consistently monitored health plans to ensure that they meet beneficiaries’ medical needs—it did not perform any annual medical audits before 2012 and performed medical audits on less than half of the health plans in fiscal year 2013-14.”  

The California Medical Association continues to monitor the situation.

For the full auditor's report, click here.


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