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The California Department of Health Services has paid at least $ 4 billion to people who may not be eligible for Medi-Cal, according to the state auditor.
A report released on Tuesday said that there were discrepancies between state and county systems when they compared people eligible for low-income health care coverage.
Other people who might have been eligible for coverage were denied service because of differences as well, the report says.
"Some eligible people may have encountered unnecessary difficulties and were inappropriately denied services," said a summary accompanying the report.
More than 13 million Californians are enrolled in Medi-Cal, which provides low-income residents with services including general health care, emergency services, dental care and mental health and mental health treatment. substance addiction.
Between 2014 and 2017, approximately 453,000 people were eligible for Medi-Cal in the state system, but were not listed in the counties. Half of these discrepancies persisted for more than two years.
Also during these four years, 170,000 people eligible for temporary benefits have had coverage beyond the allowed period, which could have cost a significant sum to the state, the report said. Most of these people were more than a year behind their coverage period.
"Nearly 12% had exceeded this period at least three years," says the auditor's report.
Although the Ministry of Health Services reported the discrepancies to the counties, the audit revealed that it did not ensure that they were resolved quickly.
The state paid $ 2.3 billion to counties for the local administration of eligibility for Medi-Cal over the past fiscal year.
The report recommends that the Department of Health resolve any discrepancies and try to recover the wrongly paid sums. The audit also suggested that the state work with counties to provide faster and easier-to-use reports in case of discrepancies.
The ministry said in a statement that it "is implementing a quality control process that will identify system anomalies and ensure that counties have the resources and technology to resolve them appropriately." ". He will report to the auditor's office on his progress by June 2019, the department said.
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The Associated Press contributed to this story
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