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Board approves letter to DHCS over state submission of ineligible Medi‑Cal claims; county estimates roughly $1.2 million at stake
Summary
The Lake County Board of Supervisors approved a letter to the California Department of Health Care Services after Behavioral Health staff said DHCS had submitted Medi‑Cal claims later adjudicated ineligible for individuals with ineligible immigration status, exposing the county to roughly $1.2 million in potential liability.
The Lake County Board of Supervisors approved a county letter to the California Department of Health Care Services (DHCS) calling attention to improperly submitted Medi‑Cal claims for individuals with ineligible immigration status and asking DHCS to review recoupment and adjudication procedures.
Behavioral Health Director Elise (Director Jones) explained that DHCS had submitted claims for services provided to individuals whose immigration status made those claims ineligible for federal matching funds. Those claims were later determined ineligible; the county has requested line‑by‑line claims detail from DHCS and is awaiting that data. Director Jones said the total effect on the county’s behavioral‑health finances is “well over a million dollars,” and later in the meeting a supervisor referenced an estimated total of approximately $1,200,000.
“I am not really expecting that they’re going to turn around and say, okay, we’re not going to do that,” Director Jones said, describing the county’s modest hopes for a full reversal but noting the county needed to flag the issue given the size of the potential liability.
Board members asked staff to coordinate with statewide groups and the county’s lobbyists. Supervisor Pyska asked staff to engage with CSAC (California State Association of Counties), RCRC and the county’s lobbyists; Chief Deputy CAO Matthew Rothstein said he would follow up and contact the county’s lobbyists on the issue. Public commenter Angela Amaral suggested copying Centers for Medicare & Medicaid Services (CMS) on the letter; Director Jones said she would consult CBHDA and county counsel about the utility of that step.
The board approved the letter with a condition allowing staff to include a cc to the federal CMS if recommended by counsel and statewide partners. The motion passed with no recorded opposition.
Why it matters: the county said the improperly adjudicated claims represent a significant fiscal concern for behavioral health services and that the issue is under discussion among California behavioral‑health directors. The county’s action asks DHCS for clarity, claims detail and reconsideration where appropriate while seeking other advocacy channels at the state and federal level.
What’s next: staff will review claim‑level data from DHCS when provided, coordinate with CBHDA and county lobbyists, and pursue further advocacy if warranted.
