Managed Care in California Series, Issue 7: Monitoring Access in the Medi-Cal Program

Executive Summary

The federal Centers for Medicare & Medicaid Services (CMS) recently approved a request by the California Department of Health Care Services (DHCS) to extend California’s 1115 Medicaid Demonstration Waiver, called the 2020 Demonstration, effective December 2015 through December 2020. The $6.2 billion demonstration project will fund several programs, including system redesign and payment innovation initiatives, with the goal of strengthening public hospitals and improving care quality for safety net populations. In the 2020 Demonstration, CMS will require DHCS to contract an outside organization to evaluate the impact of this massive expansion of Medi-Cal managed care on beneficiaries’ access to care. An independent assessment of managed care access in Medi-Cal is welcome. When DHCS has monitored access itself, it has not lived up to its obligations. Previously, DHCS promised CMS that it would monitor access to Medi-Cal benefits in fee-for-service Medi-Cal after it cut provider payment rates in 2011. But DHCS has not demonstrated that it has ensured access in Medi-Cal. Advocates will have to watch the new assessment process closely to ensure that it provides a thorough evaluation of access to services in Medi-Cal managed care.