California
California State Auditor
Published July 8, 2021

Despite the COVID-19 Public Health Emergency, the Department Can Do More to Address Chronic Medi-Cal Eligibility Problems

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Overall Conclusion

Health Care Services halted efforts to resolve hundreds of thousands of known Medi-Cal eligibility discrepancies during the public health emergency, leading to a growing backlog and increased risk of improper payments and federal penalties; some emergency waivers and communications were implemented, but more action is needed.

Source Document

Audit Scope

The audit covers Health Care Services' management of Medi-Cal eligibility and related processes during the COVID-19 public health emergency, including discrepancies between state and county data systems, eligibility alerts, waivers, and redetermination preparations.

Key Findings Summary

1

Health Care Services halted the pilot program and paused eligibility work, causing a 22% increase in eligibility discrepancies over the previous year and a backlog exceeding 500,000 as of March 2021.

2

More than 37,000 Medi-Cal beneficiaries are identified as eligible in county data systems but not in the state data system, risking access to care.

3

364,000 beneficiaries have questionable eligibility requiring county action, with an estimated monthly cost of $195 million.

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AI-Assisted

Generated by gpt-5-nano

AI Scope Summary

Future Medicaid audits should assess whether Health Care Services and counties implement the recommended actions to monitor cross-system eligibility data, resume overdue determinations, expand focus reviews, and ensure robust redetermination processes as the public health emergency ends and post-emergency operations resume.

AI-Generated Insight

During the COVID-19 emergency, the department paused key eligibility work, creating a growing backlog of discrepancies and elevated risk of improper Medi-Cal payments and federal penalties. Addressing high-risk alerts, resuming focus reviews, and enhancing county guidance are critical to stabilize eligibility determinations post-emergency.