Health Care Advocates File Suit Against California For Lag In Enrollments In Expanded Medicaid Program

By most measures the Affordable Care Act has been a success, increasing the number insured without the problems predicted by Republicans. However not everything has worked out perfectly to date. The biggest problems have been with the expansion of Medicaid. The worst problem has been seen in the Republican controlled states which have blocked Medicaid expansion, but there are also problems in some states which are attempting to participate in the program. Last May, Joe Gandelman reported at The Moderate Voice on a case in which someone he knew who was in need of immediate medical attention had difficulty obtaining coverage. It turned out that the problem was that he qualified for the expanded Medicaid program in California. As he qualified for this, he could not receive subsidies in the exchanges, but he did not receive timely coverage due to a backlog of around 600,000 people who qualified but were not processed for the program.

Since then I have looked at this backlog periodically as data came out and while the number has decreased, hundreds of thousands of people have still not received coverage. A coalition of health care advocates has now filed a suit against the state in response to this backlog. Kaiser Health News reports:

California’s lingering backlog of Medi-Cal applications has left hundreds of thousands of people unable to access the health care they are entitled to receive, according to a lawsuit filed Wednesday by a coalition of health advocates and legal services groups.

The lawsuit, filed in Alameda County Superior Court, says the state is failing to process applications within 45 days as required by law. Some applicants have been waiting to receive their Medi-Cal cards since the end of last year, according to the suit. The applicants include children, pregnant women and adults with life-threatening health conditions, who advocates say are either postponing treatment or paying cash to see doctors.

Medi-Cal is the state’s version of Medicaid, the publicly funded health insurance program for low-income Americans. About 11 million people receive Medi-Cal benefits in California, including 2.2 million who applied since January. Roughly 350,000 applications are still pending.

The lawsuit cites several cases, including that of Tulare County resident Robert Rivera, who applied for Medi-Cal in January but died of a pulmonary embolism while the state was determining if he was eligible for the insurance. Two months after his death, Rivera’s mother received a letter saying that the benefits had been approved.

Los Angeles County resident Mark Mullin submitted an application in February 2014, but wasn’t approved until four months later — after he sought legal help. During the time his application was stuck in the backlog, Mullin had to undergo an emergency appendectomy.

The suit is asking the state to process cases within 45 days and to grant people Medi-Cal benefits while officials verify applicants’ incomes. The coalition is also asking the state to send notices to Medi-Cal applicants who have been waiting for 45 days notifying them of their right to go before an administrative law judge.

The long wait is “unacceptable,” said Katie Murphy, managing attorney at Neighborhood Legal Services of Los Angeles County. Murphy said she is concerned that the problems will get worse as more people apply for Medi-Cal. “If they are not fixed, more people will continue to wait and more will continue to suffer medical emergencies,” she said.

California Department of Health Care Services officials said they have been working closely with the counties and have reduced the backlog by 250,000 since early July. Many of the cases are still pending because of incorrect or incomplete information.

Department spokesman Tony Cava said people who need immediate care can get in-person assistance with their application at a county social services agency. They also can get their medical bills covered for care received while their applications were pending, he said.

The lawsuit was filed by several organizations throughout California, including Neighborhood Legal Services of Los Angeles County, the National Health Law Program and Bay Area Legal Aid.

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