Healthcare Controversies · Access and networks
What CalViva's 2025 Access Survey Shows
Fresno, Kings and Madera: appointment standards, the audit, and what neither measures
A plan bulletin dated 28 October 2026 reports that specialist appointment availability for CalViva Health's Medi-Cal members fell below the plan's 70% goal — 58.0% for urgent, prior-authorized visits and 63.0% for non-urgent visits — while primary-care measures met it. Read with DHCS's most recent audit, the records show measured process gaps and a clear rule of retained responsibility; they do not show patient waiting times.
Stated by the operative text itself: a statute, regulation, court opinion or the study's own published results.
An official dataset, agency report, guideline or plan publication, read for what it measures and no further.
Reported by a party, news organisation or secondary summary; confined to what the reporter says.
KPSGILL analysis from structure, incentives or comparison — labeled, never promoted to fact.
A question the public record does not yet answer; the record that would answer it is named.
What was published on October 28
On 28 October 2026, Health Net published a provider bulletin reporting CalViva Health's 2025 provider access survey results for Medi-Cal members in Fresno, Kings and Madera counties DocumentedV01. CalViva is the local-initiative Medi-Cal plan for the three counties, operated by a regional health authority established in 2009 and governed by a 17-member commission that includes local physicians, county supervisors, health centers, hospitals and other stakeholders DocumentedV02. The bulletin states that the surveys, "conducted between August and December 2025, evaluated compliance with Department of Managed Health Care (DMHC) and Department of Health Care Services (DHCS) access-to-care requirements," and that "Physicians, practitioners and other providers who do not meet access standards are subject to a corrective action plan (CAP)" DocumentedV01.
The headline result is that two specialist measures fell below the plan's 70% performance goal: urgent specialist appointments requiring prior authorization within 96 hours (58.0%) and non-urgent specialist appointments within 15 business days (63.0%) DocumentedV01. Primary-care appointment measures met the goal. Two telephone and after-hours measures also fell short. The bulletin is short, plan-published and procedural; its value lies in being a dated, local, measure-by-measure record of access in a region where — as the companion analysis Half a county on Medi-Cal documents — specialist supply is well below the state's.
Specialist · urgent · 96 hours
58.0%
Requires prior authorization · goal 70% · 53.0% in 2024
Specialist · non-urgent · 15 business days
63.0%
Goal 70% · 67.0% in 2024
Primary care · non-urgent · 10 business days
84.0%
Goal 70% · 86.0% in 2024
Non-urgent callback · 1 business day
61.8%
Goal 90% · 55.6% in 2024
The results, measure by measure
| Measure | Standard | Goal | MY2025 % | MY2024 % | Against goal |
|---|---|---|---|---|---|
| Urgent appointment, primary care | 48 hours | 70% | 76.0 | 77.0 | Met |
| Urgent appointment, specialist (requiring prior authorization) | 96 hours | 70% | 58.0 | 53.0 | Not met |
| Non-urgent appointment, primary care | 10 business days | 70% | 84.0 | 86.0 | Met |
| Non-urgent appointment, specialist | 15 business days | 70% | 63.0 | 67.0 | Not met |
| Non-urgent ancillary (MRI, mammogram, physical therapy) | 15 business days | 70% | 81.0 | 91.0 | Met |
| Urgent appointment, psychiatrist | 96 hours | 70% | 70.0 | 57.0 | At goal |
| Non-urgent appointment, psychiatrist | 15 business days | 70% | 70.0 | 88.0 | At goal |
| Urgent appointment, non-physician mental-health provider | 96 hours | 70% | 80.0 | 82.0 | Met |
| Non-urgent appointment, non-physician mental-health provider | 10 business days | 70% | 87.0 | 93.0 | Met |
| Non-urgent follow-up, non-physician mental-health provider | 10 business days of request | 80% | 87.0 | 94.0 | Met |
| After-hours emergency instructions | Appropriate instructions | 90% | 93.7 | 93.1 | Met |
| After-hours contact with on-call physician | Callback within 30 minutes | 90% | 86.9 | 90.2 | Not met |
| Telephone answer time (PCP sample) | Within 60 seconds | 90% | 100.0 | 100.0 | Met |
| Callback for non-urgent issues, business hours (PCP sample) | Within one business day | 90% | 61.8 | 55.6 | Not met |
| In-office wait, primary care | 30 minutes or less | 70% | 86.5 | 72.1 | Met |
| In-office wait, specialist | 30 minutes or less | 70% | 77.2 | 77.4 | Met |
Three features of the table are easy to miss. The urgent-specialist standard applies to appointments "that require prior authorization," so the measure joins two processes — authorization and scheduling — in a single number DocumentedV01. Psychiatrist measures sit exactly at the 70% goal, with the non-urgent rate down from 88.0% the year before; at-goal is not comfortably above it DocumentedV01. And the non-urgent callback measure, at 61.8%, improved from 55.6% but remains labelled by the plan a "non-passing rate" DocumentedV01. The in-office wait measures were collected, the bulletin says, "through a provider survey" DocumentedV01.
How to read a provider-availability rate
The percentages are not patient waiting times. They are the share of surveyed provider offices that reported, or demonstrated in a survey contact, an available appointment within the standard. The bulletin describes the method: providers receive an email or fax with instructions to respond online within five business days, and "A phone survey may be conducted when" a provider does not respond or has no email or fax on file DocumentedV01. It also notes that "DMHC accepts telehealth as a valid next available appointment" DocumentedV01, and that primary-care physicians qualifying as Advanced Access Providers are treated as meeting appointment standards and exempt from the survey for three years.
Each of those features shapes the result. A next-available-appointment survey measures capacity at the moment of the survey, not the experience of a patient who calls on a different day. Counting telehealth means that an in-person specialist visit may be less available than the rate implies Inference. Exempting advanced-access practices removes, by design, some of the best-performing primary-care offices from the denominator, which would tend to lower rather than raise the primary-care rates Inference. None of these is a flaw in the survey's regulatory purpose; each is a limit on what the numbers can be used to prove.
The rates are also reported for the three counties combined. Fresno accounts for most of the plan's membership, but the bulletin does not break out county results, so a Fresno-specific specialist rate cannot be derived from it Open. Nor does it separate specialties: a 63% non-urgent specialist rate could reflect broad modest shortfalls or deep shortfalls in a few specialties. The plan's own corrective-action process will identify which providers fell short; that list is not public Open.
The DHCS audit: four findings
The access survey is the plan's own measurement. The state's most recent independent look is DHCS's medical audit for fiscal year 2024–25, covering 1 April 2024 to 31 March 2025, with fieldwork in June 2025 and a report issued on 30 October 2025 DocumentedV02. As of April 2025 the plan had 432,619 Medi-Cal members — 344,009 in Fresno, 50,015 in Madera and 38,595 in Kings — with a composition of 60% TANF-linked, 28% expansion, 7% dual-eligible and 5% seniors and persons with disabilities DocumentedV02. (DHCS's separate January 2026 report counts 508,456 certified-eligible residents in Fresno County; the difference reflects other plans, fee-for-service enrollment, and a different date and measure DocumentedV04 Inference.)
| Finding | What the auditors found | Sample |
|---|---|---|
| 1.2.1 · EPSDT in under-21 denials | “Four of five verification samples of Prior Authorization (PA) requests for members under 21 years of age did not indicate the application of EPSDT criteria in the denial process.” | 4 of 5 |
| 2.6.1 · Enhanced Care Management components | “A verification study of 20 medical records revealed that six members did not receive all ECM core service components” — including incomplete assessments and care plans, member and family supports, and enhanced coordination. | 6 of 20 |
| 2.6.2 · Notice when ECM ends | Members whose ECM was discontinued did not receive a Notice of Action informing them of the right to appeal. | 4 of 4 |
| 2.6.3 · ECM member materials | Member-facing ECM materials omitted required elements. | 2 of 5 elements missing |
The auditors reported no findings for the audit period in four categories: Network and Access to Care, Member's Rights, Quality Management, and Administrative and Organizational Capacity DocumentedV02. DHCS's corrective-action index lists the plan's corrective action plan as in progress DocumentedV03. Both halves of that record belong in any account: the absence of network and access findings for the audit period is a real result, and so are the EPSDT and care-management findings.
The samples are small. Four of five denials and six of twenty records do not estimate a plan-wide error rate, and the report does not say that any member was harmed or that any denial was clinically wrong DocumentedV02. What the findings establish is narrower and still important: in the files the auditors examined, the required pediatric standard was not shown to have been applied, and the core components of a program designed to coordinate care for high-need members were not all delivered. Those are the processes that the companion analysis Beyond the billable visit treats as the measure of completed care.
Delegation and retained responsibility
Every audit finding names the same delegate. The plan has an Administrative Services Agreement with Health Net Community Solutions under which "responsibilities delegated to Health Net include utilization management, case management, credentialing and re-credentialing, clinical and non-clinical member grievances and appeals, quality improvement and quality management functions, and administrative and organizational capacity," and a Capitated Provider Services Agreement under which care is provided through Health Net's subcontracted network DocumentedV02. The auditors' framing of responsibility is explicit: "The Plan is also required to oversee and remain responsible for any services provided by a subcontractor to ensure compliance with all applicable requirements" DocumentedV02.
This is topic 64 in its plainest form. Delegation moves the work; it does not move the accountability. A member under 21 whose denial lacked EPSDT review, or whose care management ended without notice, has a claim against the plan's obligations regardless of which organisation performed the function. The survey bulletin shows the same layering in the other direction: the corrective action plan for providers who miss access standards is issued "from Health Net" DocumentedV01. Readers trying to locate responsibility for a delayed specialist appointment therefore face at least four parties — the plan, its administrative delegate, the provider network, and the treating office — each with distinct duties. The site's analyses of network contracting, prior-authorization delays and finding a Medi-Cal specialist take the patient-facing side.
What neither record measures
What the two records establish
- Plan-reported specialist appointment availability below the 70% goal for urgent (prior-authorization) and non-urgent visits in measurement year 2025.
- Primary-care appointment availability above goal under the survey's method.
- Audit findings on EPSDT application, ECM components, ECM discontinuation notices and ECM materials, in small samples.
- That the plan, not its delegate, remains responsible for delegated functions.
What they do not establish
- Actual waiting times experienced by patients, or how many patients were unable to obtain care.
- County-level or specialty-level results.
- Any finding about a particular health center, practice or clinician.
- Whether the audit findings have been corrected; the corrective action plan was listed as in progress.
- Patient harm, or that any particular denial was wrong.
The records also do not separate health centers from other providers. A reader cannot use them to support or rebut a claim about how health centers specifically perform on access; they describe a plan network that includes health centers among many other provider types DocumentedV02 Inference.
Questions the records leave open
- Which specialties account for the shortfall in the 58.0% and 63.0% specialist rates?
- What are the Fresno-only results, separated from Kings and Madera?
- How much of the urgent-specialist shortfall is authorization time and how much is scheduling?
- What share of qualifying specialist appointments were telehealth rather than in person?
- What did the corrective action plans require of providers who missed standards, and did their results change in 2026?
- Has DHCS closed the audit's corrective action plan, and on what evidence?
- How do surveyed availability rates compare with actual time from referral to completed specialist visit for members?
- How do results compare with the other Medi-Cal plan options in the same counties?
How each side reads the numbers
A reading favourable to the plan
- Primary-care availability exceeds goal; ancillary, mental-health and in-office wait measures largely meet goal.
- The urgent-specialist rate improved from 53.0% to 58.0%; the non-urgent callback rate improved from 55.6% to 61.8%.
- The state audit found no network or access deficiencies for its period.
- Specialist shortfalls reflect a regional supply of about 83 specialists per 100,000 against 141 statewide, which no plan can fix alone.
A reading critical of the plan
- Specialist access fails the plan's own goal on both measures, and the non-urgent specialist rate fell from 67.0% to 63.0%.
- Psychiatrist non-urgent availability fell from 88.0% to exactly the 70% threshold.
- The urgent-specialist measure joins prior authorization and scheduling; a delegate controls authorization.
- The audit's EPSDT and care-management findings concern the processes that most affect high-need and pediatric members.
Both readings rest on the same published figures. The disagreement is over the counterfactual — what access would look like under different plan performance in the same supply conditions — and that is not something either record can settle Inference.
Correction history
No corrections since first publication on . Material corrections will be dated here, with the superseded text preserved and labeled.
Sources
Official issuers, statutes, opinions and original studies are preferred; reproductions of primary legal text are identified. Checked 1 November 2026 unless stated. A source that opens is not proof of every neighbouring claim.
- V01Health Net / CalViva Health, Provider Update 26-1182m, “2025 Provider Access Survey Results”
- V02DHCS, Medical Audit Report — CalViva Health, FY 2024–25
- V03DHCS, Medical Audits and Corrective Action Plans
- V04DHCS, Medi-Cal Certified Eligibles and County Population — January 2026
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