Medi-Cal Complaint Office Hasn’t Produced Quarterly Report in Nearly a Year, Despite Huge Increase in Cases

Despite having a huge increase in cases, the state office that handles complaints about health plans for low-income people hasn’t produced a quarterly report in nearly a year.

The quarterly reports help officials identify large-scale problems affecting people enrolled in the health program, called Medi-Cal.

The Managed Care Ombudsman Office typically produces a report every three months that shows the number and type of cases it’s handled for each managed-care plan in California. About 20 percent of Californians are enrolled in a Medi-Cal managed-care plan, the most common state health program for low-income residents.

Enrollment in the program has skyrocketed this year, under the Affordable Care Act.

But the state Department of Health Care Services, which oversees Medi-Cal, hasn’t produced a quarterly ombudsman report since Sept. 2013. It doesn’t expect to release more reports until November, spokesman Norman Williams said in response to a request for the documents.

The agency will release four quarterly reports, covering Oct. 2013 through Sept. 2014 later this year, he said.

The Health Care department is also behind on processing Medi-Cal applications and renewal forms. About 490,000 people are still waiting for their applications to be processed.

The ombudsman office has seen its monthly caseload increase 82 percent this year.

“Because our case volume has increased significantly, this adds to the length of time the Ombudsman’s office will need to produce the reports,” Williams said.

The office plans to produce new quarterly reports that categorize how people contact the ombudsman, such as through email, phone calls and web-based forms. The old reports, last produced in Sept. 2013, only accounted for phone calls, Williams said.

“The new report will more accurately report all of the avenues of access to the Ombudsman,” he said.

The new reports will also indicate how many cases have been resolved, according to Williams.

Since the last report was produced, the agency has been “gathering data and working to develop a new report,” spokesman Anthony Cava said.

The report is also part of a Medi-Cal Managed Care Division Performance Dashboard, which is a monitoring tool produced quarterly. The dashboard was last updated in 2013.

There is no legal requirement to produce the quarterly report, but it is one of the tools that officials use to monitor Medi-Cal’s managed-care program, Cava said.

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