Evidence record
Children Enrolled in Medi‑Cal Face Challenges in Accessing Behavioral Health Care
- Jurisdiction
- California
- Publishing agency
- California State Auditor
- Publication date
- November 28, 2023
- Source record
- Original document linked
Findings
4
Recommendations
5
Overall conclusion
The departments can do more to detect and address access challenges faced by children in Medi-Cal seeking behavioral health services. Current monitoring and survey practices have significant weaknesses, and regional disparities and provider shortages exacerbate access issues. Implementing recommended improvements could enhance timely access and ensure compliance with standards.
Scope
The audit focused on access to behavioral health services for children enrolled in Medi-Cal, examining survey methodologies, provider capacity, network adequacy, and compliance with timely access standards across California. The scope included data collection practices, monitoring efforts by DHCS and Managed Health Care, and regional disparities, covering the period up to 2022.
Findings (4)
Each finding has a stable link.
- F-231
Many Medi-Cal managed care plans are unable to provide children with timely access to behavioral health care, with significant delays in urgent and non-urgent appointments.
- F-232
Weaknesses in survey methodologies limit the accuracy of data on appointment wait times, potentially overestimating access.
- F-233
DHCS and Managed Health Care's monitoring of provider capacity and network adequacy has notable deficiencies, including approval of unreasonable standards and ineffective enforcement actions.
- F-234
Regional disparities and provider shortages contribute to unequal access to behavioral health services across California.
Recommendations (5)
- R-241
Revise agreements with managed care plans to require efforts to recruit providers in underserved areas.
Related finding F-234 - R-242
Implement policies for when noncompliance with standards justifies penalties.
Related finding F-233 - R-243
Improve monitoring of network adequacy and enforce sanctions for non-compliance.
Related finding F-233 - R-239
Revise survey methodologies to better capture appointment wait times and include reasons for provider exclusions.
Related finding F-232 - R-240
Disclose the proportion of providers excluded from survey results and reasons for exclusion.
Related finding F-232