Major enrollment problems with California’s "two-plan model" Medicaid managed care plan have meant that as many as 80% of those eligible for the program have been automatically assigned to a health plan rather than making a voluntary choice, according to a new report by the General Accounting Office (GAO/HEHS-98-2).
In the majority of the participating "two-plan" counties, consumers choose between a"local initiative" plan, which is expected to help protect traditional safety net providers, and one commercial plan.
The automatic assignment rate in two-plan counties declined to 45% between March and June 1997, but the variations between counties were dramatic—ranging from a 72% auto-assignment rate in Contra Costa County to 32% in Santa Clara County, the GAO said.
The state Department of Human Services came in for especially strong criticism in the GAO report for setting "insufficient performance standards" for the brokers responsible for enrolling more than 2.2 million beneficiaries in 12 counties. i"Performance standards should make clear the level of service expected of the broker and enable a state to gauge the sufficiency of the broker’s operations," the GAO said. "When tied to payment, performances standards can provide incentives for the enrollment broker to provide the services required and penalties for non-performance.
According to the GAO, DHS’ contract with Benova, the former enrollment broker, contained no specific performance standards. While DHS’ contract with Maximus, the current broker, contains several standards, few are tied to payment, it said. California is now planning to amend the contract.
As of July 1997, the GAO report noted that the program was more than two years behind its initial schedule, with the program fully implemented in only seven of the 12 counties.
The report is available on the Internet at http://www.gao.gov
GAO criticizes California for failure to set strong standards for enrollment brokers
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