El Dorado County Board of Supervisors Response to the

The current staffing of the HHSA Medi-Cal division is inadequate, unable to keep up with the workload from post-Covid disenrollment requests, and many employees are leaving because of the lower pay. The Board of Supervisors disagrees partially with the finding. The current staffing of the HHSA Medi-Cal division struggles to keep up with the workload that built up as a result of temporary regulatory changes related to the Covid Public Health Emergency and Med-Cal eligibility expansion that occurred as part of the state’s Healthy California for All strategy. It is not clear that the vacancy rate is related to the salary level.

The Medi-Cal eligibility specialist is a challenging position and difficult to identify and hire candidates. Onboarded employees require six months of training, with roughly 50% of those completing the process. HHSA doesn’t track the exact numbers. The Board of Supervisors agrees with the finding.

HHSA does not currently have a system for tracking Medi-Cal eligibility specialist staff productivity. The Board of Supervisors disagrees partially with the finding. The California Statewide Automated Welfare System (CalSAWS) is the automated welfare business process in California that was required to serve all 58 California counties by 2023. The implementation merged California’s previous three county-level consortia welfare systems into one system and supports six-core programs. The merger of three systems into one changed data reports that are available to counties for monitoring and tracking productivity. As a result, the EDCHHSA Leadership team now tracks productivity utilizing manual spreadsheets and system data reports that provide limited productivity data.

The HR system does not track turnover rates, which should include documentation for reason for leaving, and which would provide greater insight to staff shortages and how to improve hiring and retention rates. The Board of Supervisors disagrees partially with the finding. When an employee separates, a termination code is noted on the employee record, which provides some information about the employee’s reason for leaving. In addition, an exit survey is provided to the departing employee, but it is voluntary for the employee to complete.

Several counties have implemented the use of lower cost call centers to address basic inquiries for greater efficiency and referring enrollment steps to eligibility specialists. Currently El Dorado County relies on eligibility specialists to manage all tasks associated with inquiries to the department and calls from clients to their case workers, increasing their workload. The Board of Supervisors disagrees wholly with the finding. It is unknown whether there is a cost savings associated with the operation of call centers. Call center staff in other Counties are staffed with eligibility staff. The difference between a call center and El Dorado County’s model is that call centers process cases by individual tasks with no specific eligibility specialist assigned to the case. Call centers do not provide individualized support by specific workers. El Dorado County assigns cases to individual eligibility specialists who processes all tasks associated with each individual case and clients are given the direct name and phone number of the employee assigned to their case.