Report 2020-613 Recommendation 4 Responses
Report 2020-613: Department of Health Care Services: Despite the COVID-19 Public Health Emergency, the Department Can Do More to Address Chronic Medi‑Cal Eligibility Problems (Release Date: July 2021)
Recommendation #4 To: Health Care Services, Department of
To reduce inappropriate payments made to medical providers and ensure eligible individuals' access to care, Health Care Services should, by August 2021, resume monitoring pilot program counties' progress in resolving high-risk eligibility alerts.
CMS has confirmed the continuous enrollment requirement is now delinked from the PHE in the Consolidation Appropriations Act of 2023, (enacted December 29, 2022), which ended on March 31, 2023. DHCS began the continuous coverage requirement unwinding activities, including the resumption of annual renewals for beneficiaries due for renewal in the month of June 2023, on April 1, 2023. Please see DHCS' Covid-19 PHE Unwind Plan here for comprehensive information regarding the resumption of annual renewals. Included in the Unwind Plan is CMS' guidance supporting state agencies in returning to normal operations through a series of State Health Official (SHO) letters - December 2020, August 2021, and March 2022 and the guidance DHCS has released throughout the PHE. The new implementation date to initiate the activities is June 1, 2024.
- Estimated Completion Date: 06/01/2024
California State Auditor's Assessment of Status: Pending
In addition to the previous update, CMS has confirmed the continuous enrollment requirement is now delinked from the PHE in the Consolidation Appropriations Act of 2023, (enacted December 29, 2022), which ended on March 31, 2023. DHCS began the continuous coverage requirement unwinding activities, including the resumption of renewals, on April 1, 2023. The new implementation date to initiate these activities is May 1, 2024.
- Estimated Completion Date: 05/01/2024
California State Auditor's Assessment of Status: Pending
DHCS plans to resume all pilot program related activities, including resolution of high-risk eligibility alerts, as of the implementation date 12 months after the termination of the PHE. This will allow counties the opportunity to focus on Centers for Medicare and Medicaid Services (CMS) mandated PHE unwinding activities.
12 months after the termination of the PHE, DHCS will move forward with the original implementation plan as listed above, and on the 30-day update.
- Estimated Completion Date: 04/01/2024
California State Auditor's Assessment of Status: Pending
The estimated implementation date was extended by four months and is now November 1, 2023, due to an extension of the PHE for COVID-19. The dates of implementation are dependent on the termination date of the PHE. Therefore, when the PHE termination date is extended, the dates must be recalculated based on the new termination date. Depending on the recommendation, the implementation plan cannot begin until a certain number of months after the PHE ends.
Otherwise, no change from the previous response, which was the 12-month program update submitted to CSA on July 12, 2022.
- Estimated Completion Date: 11/01/2023
California State Auditor's Assessment of Status: No Action Taken
DHCS plans to move forward with the implementation plan provided in the previous update upon termination of the PHE with no modifications to the original plan. DHCS plans to resume all pilot program related activities, including resolution of high risk eligibility alerts, as of the implementation date, effective July 1, 2023, or one year after the termination of the PHE.
- Estimated Completion Date: 7/1/2023
California State Auditor's Assessment of Status: Pending
DHCS plans to move forward with the implementation plan provided in the previous update upon termination of the PHE with no modifications to the original plan. DHCS plans to resume all pilot program related activities, including resolution of high risk eligibility alerts, as of the implementation date, which is projected to be 12 months after the end of the PHE.
- Estimated Completion Date: 7/1/2023
California State Auditor's Assessment of Status: Pending
No change from the 60-Day update response. DHCS plans to resume all pilot program related activities, including resolution of high risk eligibility alerts, as of the implementation date.
- Estimated Completion Date: 01/31/2023
California State Auditor's Assessment of Status: Pending
No change from draft report response. DHCS plans to resume all pilot program related activities, including resolution of high risk eligibility alerts, as of the implementation date.
- Estimated Completion Date: 01/31/2023
California State Auditor's Assessment of Status: Pending
All Recommendations in 2020-613
Agency responses received are posted verbatim.