CHA News Article

Statewide Organizations Submit Joint Letter to Legislative Leadership on Medi-Cal Access to Care

Yesterday, CHA and numerous statewide organizations submitted the attached joint letter to Senator Hernandez (D-Azusa) and Assemblymember Bonta (D-Alameda), authors of Senate Bill 815 and Assembly Bill 1568, which would implement California’s section 1115(a) demonstration waiver, titled “California’s Medi-Cal 2020 Demonstration.” The waiver renewal — effective Dec. 30, 2015, through Dec. 31, 2020 – includes $6.2 billion of initial federal funding to support the state’s Medi-Cal program and its health care coverage of more than 13 million individuals. In the letter, the organizations requested additional clarification of an important component of the Medi-Cal 2020 waiver — the requirement for an independent assessment of access to care in the Medi-Cal program.  

In this one-time assessment, the Centers for Medicare & Medicaid Services (CMS) requires the California Department of Health Care Services (DHCS) to evaluate access to care for managed care beneficiaries based on the network adequacy requirements in the state’s Knox-Keene Health Care Service Plan Act and Medi-Cal managed care contracts, as applicable. It will consider State Fair Hearing and Independent Medical Review decisions as well as grievances and appeals/complaints data, and will also report on the number of providers accepting new beneficiaries. The assessment is required to include a comparison of network adequacy compliance across different lines of business and recommendations in response to any identified systemic network adequacy issues. DHCS is also required to establish an advisory committee that will provide input on the structure of the access assessment. In addition, the initial draft and final report will describe the state’s current compliance with the access and network adequacy standards in the Medicaid Managed Care proposed rule, or the final rule if published prior to submission of the assessment design to CMS.  

Over the past few years, many of the organizations represented have spent considerable time and resources highlighting program areas in which Medi-Cal access is jeopardized due to inadequate provider reimbursement rates, unfair coverage limitations, administrative barriers, and other policy and implementation challenges. The organizations recommended that the access assessment under the waiver:

  • Require the Bureau of State Audits to conduct the independent assessment.
  • Examine access to the essential health benefits.
  • Examine access to specialty mental health services.
  • Examine access to comprehensive family planning services.  
  • Examine access to skilled nursing facilities. 
  • Include an examination of payments to downstream providers.

For more information on the access assessment required under the Medi-Cal 2020 waiver, visit the DHCS website