California’s Medi-Cal program paid $4B to recipients who may have been ineligible, audit shows

Doctors examine a lung radiograph X-ray film of a patient. (iStock)

An audit released Tuesday shows that the state of California spent $4 billion between 2014 and 2017 to pay for Medi-Cal coverage for recipients who might not have been eligible for the program, according to reports.

Discrepancies between state- and county-level record-keeping may be at least partly to blame for the problem, the Los Angeles Times reported.

In one case, the report said, the state continued making payments into a resident’s health plan until August of this year – even though the resident died nearly five years ago. Payments to that resident’s plan totaled $383,000, the Times reported.

In a letter to the state Legislature that accompanied the audit, state auditor Elaine Howle wrote that “although Health Care Services has established a process for notifying counties of beneficiary records that require follow-up, gaps in this process allowed the problems we identified to persist.”

Elaine Howle, state auditor for California

"Although Health Care Services has established a process for notifying counties of beneficiary records that require follow-up, gaps in this process allowed the problems we identified to persist."

— Elaine Howle, state auditor for California

The audit found that 453,000 beneficiaries who were marked as eligible in the state records were not considered eligible at the county level, the report said – suggesting that those people may have died, moved or began making too much money to qualify for the program.

An email from the Associated Press, seeking comment from the Department of Health Care Services, which administers the Medi-Cal program, was not immediately returned.

Auditors recommended the department recover erroneous payments when possible and "implement protocols to ensure timely resolution of discrepancies."

The department was also urged to help counties address the problems.

Medi-Cal provides more than 13 million low-income Californians with services such as general health care, emergency services, dental work and mental health and substance abuse treatments.

The Associated Press contributed to this story.