United States Government Publishing Office publisher pbl distributor dst United States Government Accountability Office Health, Education, and Human Services Division author aut Government Organization text government publication eng GAOREPORTS Legislative Agency Publications gao legislative 2010-08-12 U.S. Government Printing Office 1997-10-01 monographic deposited born digital 35 p. GA 1.13:HEHS-98-2 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-98-2 P0b002ee180388d83 f:he98002 DGPO 2010-08-12 2011-03-24 GAOREPORTS-HEHS-98-2 machine generated eng fdlp REPORT GAOREPORTS-HEHS-98-2 HEHS-98-2 Health care programs Managed health care State-administered programs State/local relations Health care services Community health services Privatization Beneficiaries Disadvantaged persons California Medi-Cal Program Medicaid Program California Health Care Options Program Los Angeles County (CA) Alameda County (CA) Kern County (CA) Fresno County (CA) San Francisco County (CA) Santa Clara County (CA) San Joaquin County (CA) Contra Costa County (CA) San Bernardino County (CA) Riverside County (CA) Stanislaus County (CA) Tulare County (CA) Letter Report HEHS 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.<p/>GAO noted that: (1) despite California's extensive planning and managed care experience, implementation of its 12-county expansion program is more than 2 years behind its initial schedule and is still incomplete; (2) California originally had planned to implement the program simultaneously in all affected counties by March 1995; (3) however, as a number of unforeseen difficulties arose, the state began to stagger implementation as it became clear that some counties would be ready before others; (4) still, as of July 1997, the program had been fully implemented in only seven counties; (5) the most recent schedule estimated complete implementation in all 12 counties by December 1997, at the earliest; (6) the state's efforts to encourage beneficiaries to choose a health plan have been undermined by problems in the process for educating and enrolling beneficiaries; (7) according to the Health Care Financing Administration (HCFA), beneficiary and provider advocates, and managed care plans, a number of problems contributed to confusion for many beneficiaries, including incorrect or unclear information about the mandatory Medi-Cal program and participating plans as well as erroneous assignments of beneficiaries to plans; (8) available data show that, on average, almost half of affected beneficiaries have not actively chosen their own plan but instead have been automatically assigned to one by the state; (9) other problems were evident in California's Department of Health Services' (DHS) management of the program, including insufficient performance standards for enrollment brokers and poor internal communication and weak ties with advocacy and community-based organizations; (10) California has taken a number of actions to improve the implementation and administration of its mandatory expansion program; (11) DHS also has taken steps to work more closely with community-based organizations to improve outreach efforts; (12) however, these actions were taken too late to benefit the many beneficiaries who have already enrolled in the seven counties where full program implementation has been completed; (13) HCFA is in the process of developing federal guidelines on designing and implementing an education and enrollment program; and (14) despite the fact that the state's 12-county expansion program was designed to help ensure that federally qualified health centers, community and rural health centers, and other safety-net providers participate in the provider networks, some safety-net providers have reported difficulty maintaining their patient base. https://www.govinfo.gov/content/pkg/GAOREPORTS-HEHS-98-2/html/GAOREPORTS-HEHS-98-2.htm https://www.govinfo.gov/content/pkg/GAOREPORTS-HEHS-98-2/pdf/GAOREPORTS-HEHS-98-2.pdf GAO/HEHS-98-2 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-98-2 Letter Report GAO/HEHS-98-2; Medicaid Managed Care: Delays and Difficulties in Implementing California's New Mandatory Program; Health care programs Managed health care State-administered programs State/local relations Health care services Community health services Privatization Beneficiaries Disadvantaged persons California Medi-Cal Program Medicaid Program California Health Care Options Program Los Angeles County (CA) Alameda County (CA) Kern County (CA) Fresno County (CA) San Francisco County (CA) Santa Clara County (CA) San Joaquin County (CA) Contra Costa County (CA) San Bernardino County (CA) Riverside County (CA) Stanislaus County (CA) Tulare County (CA)