California May Have Paid $4.4 Billion to Ineligible Medi-Cal Recipients

November 21, 2018 Updated: November 21, 2018

A California state audit released Oct. 30 has revealed problems with the state’s Medi-Cal system.

The state spent $4.4 billion on Medi-Cal coverage between 2014 and 2017 for people who may not have been eligible for the plan, the audit reported.

The audit found 453,000 beneficiaries who were marked as eligible in the state’s system, but not in the county’s, indicating that they may not have actually been eligible, the LA Times reported.

The people may have died, moved, or begun making more money.

To qualify for Medi-Cal, a single adult must make less than $16,754 annually.

Meanwhile, the audit also found 54,000 people who were marked eligible in the county system, but not the state, which may have delayed or made it difficult for them to access services for which they did not qualify, the LA Times reported.

“These individuals may have experienced hardships in accessing health care services, as they would have been denied benefits until the system discrepancies were resolved,” the audit stated.

Although the Department of Health Care Services notified counties of the discrepancies, the audit found that it did not make sure they were resolved quickly.

The report recommended that the Health Department resolve the discrepancies and implement a better system by the end of the year. It also recommended that the state recover erroneous payments by June of next year.

The Department said in a statement that it is “implementing a quality control process that will identify system discrepancies, and will work to ensure that counties have the resources and technology needed to appropriately resolve discrepancies.”

It also states that while it agrees with the recommendations, it cannot comply with them in the suggested time frame.

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