Report 2014-134 Recommendation 8 Responses

Report 2014-134: California Department of Health Care Services: Improved Monitoring of Medi-Cal Managed Care Health Plans Is Necessary to Better Ensure Access to Care (Release Date: June 2015)

Recommendation #8 To: Health Care Services, Department of

To further ensure that it can handle adequately the volume of calls from Medi-Cal beneficiaries, after upgrading or replacing its systems, if Health Care Services believes that it does not have adequate staffing to address workload, it should justify its need and request additional staff.

1-Year Agency Response

No update from the 6 month update. However, providing CSA requested documentation.

6-month Update: The new Ombudsman phone system was successfully implemented on September 30, 2015. The new phone system has expanded incoming call capacity with call back features, in addition to a more robust phone tree referral mechanism. In January 2016, the Office of the Ombudsman will release public data related to the implementation of the new phone system. Seven positions are currently filled with the remaining two in the final stages of recruitment.

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

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

Health Care Services' response does not address whether or not it needs to request additional staff to address workload. During follow-up communication, Health Care Services stated any discussion of additional resources or assessments will be handled in the 2017-18 budget process.

  • Auditee did not address all aspects of the recommendation

6-Month Agency Response

The new Ombudsman phone system was successfully implemented on September 30, 2015. The new phone system has expanded incoming call capacity with call back features, in addition to a more robust phone tree referral mechanism. In January 2016, the Office of the Ombudsman will release public data related to the implementation of the new phone system. Seven positions are currently filled with the remaining two in the final stages of recruitment.

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

California State Auditor's Assessment of 6-Month Status: No Action Taken

During follow-up with Health Care Services regarding the positions it refers to in its response, it stated that the nine positions are existing limited term positions and eight positions are filled. Health Care Services stated that it will not fill the ninth position as it expires in March 2016. Health Care Services also stated that at this time a decision has not been made on whether additional positions are necessary. Health Care Services stated that further assessment is required.

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

60-Day Agency Response

The new Ombudsman phone system is currently in development and expected to be operational in September 2015. DHCS has received approval for 9 Limited Term positions from the legislature beginning July 1, 2015.

  • Estimated Completion Date: September 2015
  • Response Date: August 2015

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

Health Care Services did not provide evidence to support its assertion that it received approval for 9 Limited Term positions to address workload related to calls from Medi-Cal beneficiaries.


All Recommendations in 2014-134

Agency responses received are posted verbatim.


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