Medicaid Managed Care: Delays and Difficulties in Implementing California's New Mandatory Program
Highlights
Pursuant to a congressional request, GAO reviewed California's Medicaid Program, Medi-Cal, focusing on: (1) the implementation status of California's managed care expansion, including identifying the primary causes of delays; (2) the degree to which state efforts to educate beneficiaries about their managed care options and enroll them in managed care have encouraged beneficiaries to choose a plan; (3) the management of the state's education and enrollment process for the new program, including state and federal oversight of enrollment brokers that the state contracted with to carry out these functions; and (4) the impact of the managed care expansion on current safety-net providers, such as community health centers, that serve low-income beneficiaries.
Recommendations
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of Health and Human Services | To help states design and implement Medicaid managed care programs that ensure beneficiaries who enroll, especially those who are mandated to do so, are able to make an informed choice in selecting a plan, the Secretary of Health and Human Services should direct HCFA to promptly finalize guidelines for developing and operating an education and enrollment program. To help ensure accountability, these guidelines should include considerations regarding appropriate performance standards and measures and monitoring mechanisms, especially when a state contracts out these functions to an enrollment broker. |
CMS has issued final managed care regulations, which address some issues of quality and guidelines regarding education and enrollment programs.However, CMS has no plans to take further action in issuing guidelines on education and enrollment in the near future. CMS noted that there are other Managed Care priorities at this time, such as revising the Contract Review checklist and ratesetting guide, revising section 1915(b) waiver applications, revising the State Medicaid Manual, and revising the monitoring guide that take higher priority. CMS further stated that it is not sure when or if the agency will get to the enrollment guide, but that it won't be soon. Some of the efforts noted above will touch on enrollment broker policies, but it is not the same as a separate guide.
|