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Joint legislative committee orders audit of Medi-Cal managed care provider networks



August 22, 2014
Area(s) of Interest: Payor Issues and Reimbursement Public Payors 

After complaints of major inaccuracies in Medi-Cal managed care provider directories, a state legislative committee has ordered the independent State Auditor to conduct a review of certain managed care plans and the state’s oversight of those plans. About 20 percent or 7 million California residents are currently enrolled in a Medi-Cal managed-care plan.


“I want to know if there if there are primary care doctors accepting new patients and whether the Department of Health Care Services has complied with state and federal regulations on physician availability,” said Sen. Ricardo Lara, Vice-Chair of the Joint Legislative Audit Committee, after hearing numerous stories of Medi-Cal managed care patients being unable to find a doctor.


An investigative story by the California Health Report found that, on average, more than half of the primary care doctors in Medi-Cal managed care provider directories given to patients in three counties they examined were not accepting new patients.


In one plan in Butte County, more than 95 percent of the doctors listed in the printed directory were either unavailable to new patients or were unreachable. Other physicians listed in the county directory had moved from the area or had stopped practicing medicine. Still, others that were listed had never accepted Medi-Cal.


The Medi-Cal program is responsible for 46 percent of all births in California, Sen. Lara said at a press conference last week. “Fifty percent of beneficiaries are children,” he said. This is a key program for our state and “the accuracy of directories is critical to ensure that our most vulnerable populations receive the health care they need.”


At the same press conference, Richard Thorp, M.D., president of the California Medical Association, said that the number of doctors participating in Medi-Cal has dropped precipitously since physician reimbursement was cut by 10 percent in January. Dr. Thorp, an internist in rural Butte County, has found it difficult to access specialty care physicians for his Medi-Cal patients.


“One of my patients needed a gastroenterologist. The closest specialist accepting Medi-Cal was in Escondido – 700 miles away.” He said the accuracy of the directory is key to the Medi-Cal debate over adequate provider networks.


The “alarming findings” in the most recent reports caused Sen. Lara to ask the state auditor to investigate the matter. “This request, I believe, is about making sure we deliver on the promise of providing for the care of Medi-Cal beneficiaries,” he said.


The audit is expected to take six to eight months to complete.

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