Medi-Cal applicants entitled to benefits despite delays, judge rules
January 23, 2015 Los Angeles Times
California may no longer leave applicants in limbo as they wait to find out whether they qualify for the state’s healthcare program for the poor, a superior court judge has ruled.
In a sharply worded decision issued in Alameda County on Tuesday, Judge Evelio M. Grillo wrote that the California Department of Health Care Services must provide Medi-Cal applicants with temporary benefits if it takes longer than 45 days — the time allowed by state law — to determine their eligibility.
The decision should prevent the lengthening of an administrative backlog as applications to the program continue to roll in, said Jen Flory, senior attorney at the Western Center on Law and Poverty, an advocacy group that helped bring the suit to court.
For many low-income Californians, the expansion of Medicaid under the Affordable Care Act has proved a mixed blessing.
When California decided to participate in Medi-Cal — the state’s version of Medicaid — vast numbers of people became newly eligible.
Many applications were delayed months before receiving a determination of eligibility. In some cases, those people awaiting rulings had trouble accessing medical care, advocates said.
The lawsuit was filed on behalf of several patients who claimed to have been harmed by the Medi-Cal delays.
Rivera died of a pulmonary embolism two months before his coverage was approved. On Tuesday, his mother said she was happy that others wouldn’t suffer the same fate.
“People who need Medi-Cal will be able to get it in a timely manner,” she said in a statement issued by healthcare advocates. “Hopefully somebody’s life will be saved because of this decision.”
More than 2.7 million people have been signed up under Medi-Cal since the Affordable Care Act took effect on Jan. 1, 2014, the agency said. In all, around 12 million Californians receive Medi-Cal benefits.
Agency spokesman Norman Williams told the Los Angeles Times that around 45,000 applications remained pending. Many, he said, were duplicates that would have to be weeded out.
“We’re working as quickly as possible,” he said.
Advocates who had been grappling with the agency over the delays struck a conciliatory tone on Thursday.
“Even though this has been adversarial, we know that the state and the counties are working very hard,” said Cori Racela, an attorney at Neighborhood Legal Services of Los Angeles County, one of the groups that brought the lawsuit.
“We all have the same end goal: to get eligible people benefits,” she added. “We’re just glad the court aligned with our view of how that should happen.”
By Eryn Brown