Advocates File Lawsuit Alleging California’s Separate and Unequal Medi-Cal System Violates the Right of Millions, Reports SEIU-UHW

By a News Reporter-Staff News Editor at Insurance Weekly News -- State officials are violating the civil rights of 13.5 million individuals enrolled in Medi-Cal, the health insurance program for low-income Californians, a majority of whom are Latino, according to a lawsuit filed Wednesday.

The suit, filed in Alameda County Superior Court, alleges that Medi-Cal patients face huge obstacles in obtaining timely access to care because the state pays providers so little for their services that many doctors decline to accept Medi-Cal patients. Those problems are further compounded by the state's failure to adequately monitor and oversee the program, according to the lawsuit.

MALDEF (Mexican American Legal Defense and Educational Fund), CREEC (Civil Rights Education and Enforcement Center) and the law firm of Feinberg, Jackson, Worthman & Wasow LLP filed the suit on behalf of individuals, including a man who has cerebral palsy and is semi-paraplegic, as well as St. John's Well Child & Family Center, SEIU-United Healthcare Workers West (SEIU-UHW), and National Day Laborer Organizing Network (NDLON).

"Medi-Cal is a critical program to so many of California's children and adults; it is no exaggeration to say that our current and future workforce - our very prosperity as a state - depends on Medi-Cal providing access to vital physician care," said Thomas A. Saenz, MALDEF president and general counsel. "We must ensure that Medi-Cal is administered in a fair and non-discriminatory manner that serves the healthcare needs of Latinos and all others enrolled in the program."

At issue is Medi-Cal patients' inability to access the care they need because of low reimbursement rates and unnecessary red tape.

Currently, California's rates are so much lower than Medicare and employer-sponsored insurance rates that they discourage participation by healthcare providers and leave Medi-Cal recipients with few options, according to the lawsuit. With so few Medi-Cal providers, patients are frequently unable to find the primary and specialty care they need. When they do, they often wait weeks or months for appointments, or must often travel long distances - effectively denying them meaningful health care, according to the complaint.

"California is required by law to provide Medi-Cal health insurance participants access to healthcare equivalent to the access of people with other insurance coverage, including employer-sponsored insurance and Medicare," said Bill Lann Lee, senior counsel of the Civil Rights Education and Enforcement Center (CREEC), and a former assistant attorney general for civil rights at the U.S. Department of Justice. "In the past, when Medi-Cal was a predominantly white program, access was better because the reimbursement rates were closer to other insurance reimbursement rates. That changed when the Medi-Cal program became increasingly Latino and then majority Latino. That is discrimination."

The lawsuit alleges the Medi-Cal program is discriminatory because as the number of Latino enrollees has increased, reimbursement rates have decreased, in violation of state civil rights protections.

Among those struggling to receive adequate healthcare access are Analilia Jimenez Perea and her son, Saul, who are two of the named plaintiffs in the civil rights suit. Saul is a Medi-Cal patient who has cerebral palsy and is semi-paraplegic. He suffers from severe seizures that have required frequent hospitalizations, but Analilia has had an extremely difficult time finding doctors who will see him. In one instance, they waited a year and a half for an appointment with a neurologist.

"It's very sad when I try to get an appointment for him at a special clinic and they are happy to speak to me until they learn he has Medi-Cal, and then they either turn us away or tell us we'll have to be put on a waiting list," said Analilia.

Latinos in California have rapidly become the largest group of people receiving their health care through Medi-Cal. In 2000, 2.3 million Latinos were enrolled in Medi-Cal. By 2016, that number had risen to 7.2 million, a clear majority of the Medi-Cal population. In that same time frame - 2000 to 2016 - Medi-Cal payments to health providers fell 20 percent compared to what Medicare pays for the same services.

Medi-Cal reimbursement rates to health providers are 48th in the nation. In many cases, the reimbursement rate is lower than a physician's cost of providing care. Similar problems exist with managed care.

"These statistics show that California has created a separate and unequal system of health care, one for those with private insurance and Medicare, and an inferior one for those in the majority Latino Medi-Cal program," said Catha Worthman, one of the lawyers and a partner at Feinberg, Jackson, Worthman and Wasow LLP.

"The physical effects of Medi-Cal's inadequacy are brutal and the result of this unfair system, in a nutshell, is that everyone loses," said Jim Mangia, president & CEO of St. John's Well Child and Family Center. "It is time for California's state government to stop undermining the fundamental human right to health. It is time for California to stand up and provide the comprehensive, affordable health care that every resident of this state deserves."

"Healthcare is a fundamental human right, yet it remains inaccessible for many day laborers and low wage workers," said Cal Soto, worker rights coordinator for NDLON. "When every penny earned is vital to keeping a household afloat, an untreated illness or injury could severely disrupt the well-being of the entire family. It is unacceptable that Medi-Cal sometimes reimburses at less than half the rate of other health insurers. California has the highest GDP of any state in the country, and we must continue to fight to ensure that our immigrant community is not provided with second-class healthcare coverage."

Keywords for this news article include: Medicare, Legal Issues, Health Policy, Cerebral Palsy, Health Insurance, Chronic Brain Damage, Brain Diseases and Conditions, SEIU-United Healthcare Workers West, Central Nervous System Diseases and Conditions.

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