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Auditor’s Report Shows ‘Symbiotic Relationship’ In Medi-Cal Managed Care

Author | Shield HealthCare
07/07/15  6:22 PM PST
Medicaid in Washington

The seeming reluctance by state officials to closely monitor Medi-Cal managed care plans is troubling, said Gerald Kominski, director of the UCLA Center for Health Policy Research.

Reacting to a June report from the California State Auditor’s office that criticized the Department of Health Care Services for lax oversight of Medi-Cal managed care plans, Kominski said the report illustrates an interesting dynamic between the private managed care insurers and the public agency officials who depend on those plans to care for most of the 12.3 million Californians on Medi-Cal.

“The dynamic is that, in this market, there’s an implicit understanding that the state isn’t going to be too demanding in terms of data reporting, because they don’t want to alienate the relatively small number of players in the market,” he said.

The state needs costs contained, Kominski said, and that may sometimes be at odds with the public directive to ensure timely access to high-quality care.

“There may be a recognition that you won’t pressure us too much on performance and we won’t pressure you too much on price,” Kominski said. “It’s a symbiotic relationship.”

The audit found multiple inaccuracies in provider directories and said DHCS can’t actually determine if provider networks are adequate because it hasn’t verified plan data. Patient access to care may be compromised by a lack of monitoring, the audit said, and complaints haven’t been handled properly.

Continue reading the complete article at California Healthline

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