2022-112 Audit Scope and Objectives
CalOptima
The audit by the California State Auditor will provide independently developed and verified information related to CalOptima's budget, delivery of services and programs, and organizational changes. The audit's scope will include, but not be limited to, the following activities:
- Review and evaluate the laws, rules, and regulations significant to the audit objectives.
- Examine CalOptima's budget, including the amount of revenue CalOptima receives from federal, state, and private sources, and determine whether CalOptima makes its budget and financial information available to the public.
- Evaluate CalOptima's reserve balances since the Affordable Care Act went into effect in 2014 and determine whether the balances comply with applicable requirements and how they compare to other public Medi-Cal managed care plans.
- Determine how CalOptima collects and spends intergovernmental transfer funding and how much of this funding it retains. Compare the amounts CalOptima collects in this manner to those of other public Medi-Cal managed care plans.
- Identify the Homeless Health Initiatives or other programs that CalOptima operates to provide services to Orange County's homeless population. Determine the amounts budgeted, spent, and remaining for those programs, and whether CalOptima makes this information available to the public.
- Determine whether CalOptima complies with requirements associated with its receipt of federal and state funding for programs that CalOptima operates to provide services to Orange County's homeless population.
- Evaluate CalOptima's successes and challenges in meeting the goals of its programs that provide health care services to the homeless population of Orange County.
- Determine whether CalOptima provides timely access to care for patients, including the homeless population of Orange County.
- Compare CalOptima's executive management turnover rates since 2014 against the turnover rates of other public Medi-Cal managed care plans. Evaluate CalOptima's hiring practices and job requirements and identify the effect that those practices and requirements may have on hiring and retention. Compare CalOptima's salaries and credential requirements to other county-organized health systems.
- Determine whether CalOptima has established mechanisms for its staff and contractors to report misconduct and whether CalOptima has taken sufficient action to maintain an atmosphere free from the fear of retaliation for people using those mechanisms.
- Review and assess any other issues that are significant to the audit.
California State Auditor's Office
06/27/22
