June 1, 2021

There is no question that the public health emergency has had wide-ranging impacts on the health of Californians and on the health care sector as a whole. As community concerns grew about the spread of COVID-19 and the safety of taking part in everyday activities, routine visits to the doctor declined drastically. By August of last year, the number of children visiting doctors through the Medi-Cal program dropped by 40% from the prior year. California saw declines in children’s utilization of preventive and routine care across various services, including dental care, mental health visits, vaccinations, and outpatient care. And, although the number of children accessing care decreased drastically during the pandemic, and pediatric visits still have not recovered to “levels seen in a typical year,” the reality is that the Medi-Cal managed care system was significantly underperforming for kids long before shelter-in-place orders took effect in California.

Overall health plan performance on children’s preventive services was abysmal. Statewide averages on preventive care measures maxed out at 61% – well below the goal that all children get pediatrician-recommended preventive care. Utilization rates for preventive services were also much lower for children of color and children living in households speaking a primary language other than English, highlighting the racial gaps in access to care. As we point out in our new analysis, Accountability for Medi-Cal Children’s Preventive Services: Medi-Cal Health Plans are Key to the Preventive Care Guarantee for Kids, none of California’s 56 Medi-Cal health plan units qualify as “high performing” when it comes to children’s preventive care because no health plan was near 100% on any measure. State officials must use their oversight authority of managed care plans to implement meaningful action, like financial withholds, for health plans that demonstrate substandard performance and are failing to meet the health needs of all children on Medi-Cal.

DHCS already has significant oversight and monitoring authority over its contracted health plans, but poor execution of this authority has contributed to the persistently low utilization rates. The data is clear. DHCS has the responsibility to use this data to drive bold and targeted action for quality improvement among its contracted Medi-Cal health plans. As the Los Angeles Times has editorialized, “California now has a rare opportunity to force health insurers to do more to improve the care” of their Medi-Cal members. The state’s upcoming Medi-Cal managed care procurement process is a once-in-a-childhood opportunity to act on this troubling data and take steps to advance health equity. By way of re-writing the managed care contracts, the State must significantly increase standards and oversight of Medi-Cal managed care plans by holding them accountable for regularly providing quality care for kids. Simply put, if plans do not ensure kids are adequately accessing preventive care, the state should not pay them billions of dollars.

To learn more, please read the corresponding issue brief, Accountability for Medi-Cal Children’s Preventive Services: Medi-Cal Health Plans are Key to the Preventive Care Guarantee for Kids.