Report 2020-613 Recommendation 6 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 #6 To: Health Care Services, Department of

To ensure that it is addressing weaknesses in the counties' processes for making eligibility redeterminations, Health Care Services should resume county monitoring via focus reviews within four months of the end of the public health emergency.

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 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.

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.

California State Auditor's Assessment of Status: Pending

DHCS will resume focus reviews 12 months after the termination of the PHE. This will allow counties the opportunity to focus on 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.

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.

California State Auditor's Assessment of Status: No Action Taken

The implementation plan dates were extended six months due to the extension of the PHE. CSA recommends focus reviews to resume four months after the termination of PHE; however, due to work volume post-PHE operation, counties should be allowed a 12-month timeframe. 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 will resume focus reviews effective July 1, 2023, or one year after the termination of the PHE due to the level of effort needed at the county level in the year after the end of the PHE, and to ensure counties perform all PHE related activities timely.

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 will resume focused reviews 12 months after the termination of the PHE (currently projected to be July 2023) due to the level of effort needed at the county level in the year after the end of the PHE, to ensure counties perform all PHE related activities timely.

California State Auditor's Assessment of Status: Pending

No change from the 60-Day update response. DHCS will resume focused reviews in January 2023, due to the level of effort needed at the county level in the 12 months preceding the end of the PHE, to ensure all PHE related activities are completed timely.

California State Auditor's Assessment of Status: Pending

No change from draft report response. DHCS will resume focused reviews in January 2023, due to the level of effort needed at the county level in the 12 months preceding the end of the PHE, to ensure all PHE related activities are completed timely.

California State Auditor's Assessment of Status: Pending

All Recommendations in 2020-613

Agency responses received are posted verbatim.