Report 2014-130 Recommendation 4 Responses

Report 2014-130: California Department of Health Care Services: It Should Improve Its Administration and Oversight of School‑Based Medi-Cal Programs (Release Date: August 2015)

Recommendation #4 To: Health Care Services, Department of

Until the Legislature implements our recommendation in Chapter 2, Health Care Services should immediately resolve weaknesses in its oversight of local educational consortia and local governmental agencies to ensure that these entities sufficiently meet their responsibilities under the administrative activities program and meet the terms of their contracts with Health Care Services. Health Care Services should complete the oversight reviews for at least three high-risk local educational consortia or local governmental agencies by December 31, 2015, and post the results to its website.

Annual Follow-Up Agency Response From September 2017

No update - DHCS completed the three high-risk LEC/LGA site visits on December 31, 2015.

  • Completion Date: December 2015

California State Auditor's Assessment of Annual Follow-Up Status: Partially Implemented

We cannot confirm that Health Care Services fully implemented this recommendation; it did not provide us with copies of the results of its site visits. Furthermore, Health Care Services previously told us that although it shared the site visit results with the entities it reviewed, it would not post the results on its website but would share that information through the Public Records Act process if requested.

  • Auditee did not substantiate its claim of full implementation

1-Year Agency Response

As noted in the six-month update, site visits for the three high-risk LEC/LGAs were completed by December 31, 2015.

  • Completion Date: December 2015
  • Response Date: September 2016

California State Auditor's Assessment of 1-Year Status: Partially Implemented

In its response, Health Care Services indicated that it had fully implemented this recommendation and that it had completed its reviews of three local educational consortia or local governmental agencies by December 2015. However, we are unable to verify that these reviews occurred because Health Care Services has not provided us with copies of the results of its reviews as we requested in June 2016 and again in July 2016.

Health Care Services also told us that although it shared the site visit results with the entities it reviewed, it would not post the results on its website but would share that information through the Public Records Act process if requested.

  • Auditee did not substantiate its claim of full implementation
  • Auditee did not address all aspects of the recommendation

6-Month Agency Response

Adhering to the findings contained in the 2013 Centers for Medicare and Medicaid Services Financial Management Report, the School Based Medi-Cal Administrative Activities Unit performed site visits for school districts within the LACOE on September 30, 2015, the Tulare LGA on October 21, 2015, and the Stanislaus LEC on October 28, 2015. All three site visits revealed minor infractions that would only require administrative corrections and there were no findings that would require a financial correction. This task was completed by December 31, 2015, as projected.

  • Completion Date: December 2015
  • Response Date: March 2016

California State Auditor's Assessment of 6-Month Status: Partially Implemented

In its posted response, Health Care Services indicated that it completed its reviews of three local educational consortia or local governmental agencies by December 2015. However, in response to our follow-up questions, Health Care Services told us that although it shared the site visit results with the entities it reviewed, it would not post the results on its website but would share that information through the Public Records Act process if requested. Health Care Services also did not provide us with copies of the results of its reviews as we requested.

  • Auditee did not substantiate its claim of full implementation

60-Day Agency Response

Based on the 2013 Centers for Medicare and Medicaid Services Financial Management Report, the SMAA Unit's experience in reviewing claims during the Reasonable Test Criteria process, and comments from the California State Auditor's August 2015 audit report, we have chosen three LEC/LGAs for site visits. The three site visits are scheduled as follows: Los Angeles County Office of Education on September 30, 2015; Tulare LGA on October 8, 2015; and Stanislaus LEC on October 22, 2015. These site visits will be completed by December 31, 2015.

  • Estimated Completion Date: December 2015
  • Response Date: October 2015

California State Auditor's Assessment of 60-Day Status: Pending


All Recommendations in 2014-130

Agency responses received are posted verbatim.


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