Children Now Insider: Children and Families Need Better Access to Health Care

How the Administration’s leadership can improve Medi-Cal, and health outcomes for CA kids

By Mike Odeh
Director, Health

November 27, 2019

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Earlier this month, the Senate Committee on Health and the Assembly Committee on Health held a joint informational hearing focused on Medi-Cal access to care, marking six months since the State Auditor released a report highlighting major concerns about Children’s Preventive Health Services.

The hearing featured testimony from the California State Auditor, the Department of Health Care Services (DHCS) and several stakeholders including the American Academy of Pediatrics, the Central California Alliance for Health, and Children Now. You can view the agenda here, and a complete recording of the hearing is available online.

Children’s access to care in Medi-Cal has been a long-standing problem that benefits neither kids nor taxpayers, but perhaps the Medi-Cal managed care system is simply producing the outcomes it has been designed to – and that needs to change. Roughly half of California kids under the age of five are covered by Medi-Cal. That means that if we don’t begin to hold plans accountable for delivering services to kids that are required by law, then nearly half of our kids will be growing up without adequate health care. And, a recent report from the California Health Care Foundation showed that the rates of childhood immunizations and children’s access to primary care physicians have declined or stayed stagnant over the last decade.

Leadership from the Newsom Administration

When he took office earlier this year, Governor Newsom inherited a Medi-Cal managed care delivery system plagued by contracts that were not designed to promote quality care for kids, and which have suffered from inconsistent and ineffective contract oversight, as the State Auditor’s report Department of Health Care Services Millions of Children in Medi-Cal Are Not Receiving Preventive Health Services shows.

It’s up to the Administration to provide the leadership needed to start turning this around and ensure that children receive the basic preventive care services that are required by federal law under the Medicaid Early and Periodic Screening, Diagnostic and Treatment or EPSDT benefit. To do this, the Administration should undertake Medi-Cal contract and payment reforms next year that definitively prioritize quality EPSDT care for kids.

According to the State Auditor’s report, released in March of this year …

  • California ranks 40th for all states in providing preventive health services to children;
  • An annual average of 2.4 million children enrolled in Medi-Cal do not receive all required preventive services;
  • There are not enough providers accepting Medi‑Cal patients in many parts of the State; and
  • Many children may not be receiving necessary care because their families are unaware that, in some instances, there may be a provider closer to where they live than the one their plan offers.

Actions for the Department of Health Care Services

While DHCS should adequately address all of the Auditor’s recommendations, two recommendations are especially critical. First is the recommendation that DHCS should ensure eligible children and their families know about all the preventive services they are entitled to under Medi-Cal. This means explaining in plain language to parents and caregivers that EPSDT preventive services are the Bright Futures services – a national health promotion and prevention initiative, led by the American Academy of Pediatrics, that provides guidance for all preventive care screenings and well-child visits – for all age groups. We appreciate that DHCS is willing to invest the time necessary to collaboratively work with stakeholders to develop a consumer notice that effectively informs parents about preventive services in an understandable and respectful way. Fortunately, DHCS has several excellent examples and models to look to – like this colorful, family-friendly pamphlet released by the Wisconsin Medicaid program or the materials from the Department’s very own Smile, California! campaign on the Medi-Cal Dental benefit that was very well received by families.

Second, the Audit recommends that DHCS establish performance measures that cover the span of Bright Futures preventive services included as part of the EPSDT package. To address this recommendation, DHCS has indicated they are working on developing a “Preventive Services Utilization Report” for children that would track and measure performance on preventive services. During the hearing Children Now strongly urged the Department to prioritize the release of a preliminary or draft of this report by year-end given the persistent requests for this kind of baseline information from stakeholders and advisory panel members.

This is important because the establishment of future performance measures through Medi-Cal contracts and payments should be done in a holistically kid-focused, outcomes-based way that more appropriately leverages the managed care business model. To be clear, Children Now will be looking for the state to establish and enforce strong managed care plan contracts that will align accountability measures with financial and other incentives in a way that will drive performance improvement and promote disparities reductions for kids.

Next Steps

DHCS announced that there will be more stakeholder communication in the first part of 2020 around the managed care procurement request; and Senate Health Committee Chair Dr. Richard Pan (D – Sacramento) has indicated the strong legislative interest in the managed care contracts. These are promising next steps, but must be tracked closely so that kids are a priority in both the contract language and the procurement selection process.

The managed care procurement process coming up presents a real and crucial opportunity to rectify the access issues identified in the Audit, and to make a positive and lasting imprint in the way the state delivers and pays for children’s preventive care through Medi-Cal for years to come.

Children Now and other members of the Medi-Cal Managed Care Advisory Group will discuss the issues raised at this hearing during their next meeting on December 5. To learn more, please visit https://www.dhcs.ca.gov/services/Pages/ManagedCareAdvisoryGroup.aspx.