Lawsuit Filed over Medi-Cal Backlog of 350,000 Stranded Applicants

Friday, September 19, 2014
(photo: Santa Cruz Sentinal)

California has been signing up record numbers of new Medi-Cal patients since passage of the federal Affordable Care Act, and has also accumulated a record backlog of Medi-Cal applications that have remained unprocessed, stranding people without insurance.

On Wednesday, a group of patients and health care advocates filed a lawsuit in Alameda County Superior Court demanding that the state abide by federal law and enroll those applicants immediately. “We cannot have a system that discriminates like this,” attorney Katie Murphy told the Los Angeles Daily News. “People are going without care.” Murphy works for the Neighborhood Legal Services Los Angeles, one of the organizations that filed the suit.

Approximately 350,000 people submitted Medi-Cal applications as of September 1 but remain in limbo. That’s down from 900,000 in May when computer problems and an onslaught of new applicants stormed the system after an aggressive campaign by the state and federal governments to recruit them. 

The goal was to give the most vulnerable low-income and otherwise disadvantaged citizens affordable health care by expanding the reach of Medi-Cal, California’s version of the federal Medicaid program. It worked.

The state added 2.2 million people to the 8.8 million already signed up. But federal law requires that applicants be processed in 45 days and that’s not happening.

Until now, the success of the Affordable Care Act has been measured by the number of people who sign up for insurance in either one of the insurance exchanges, like Covered California, or Medi-Cal/Medicaid. As problems with narrow hospital and doctor networks and backlogs surface, more attention is being paid to actual access to the health care system.

Eventually, Obamacare will be measured by health outcomes, not the length of enrollee signup sheets. A healthier population will help take the political sting out of people having to navigate buggy websites, dodge computer problems, find doctors and hospitals who accept new patients, and wait out Medi-Cal backlogs.

But it might not be of much comfort to thousands of people potentially caught without Medi-Cal they are legally entitled to.

One of the plaintiffs in the lawsuit, Visalia resident Frances Rivera, is suing because her son Robert applied for Medi-Cal in January but died from a pulmonary embolism two months before his application was approved in June. The suit says Robert delayed some treatment while he was uninsured because of the expense.

Last week, a legislative committee in Sacramento asked California State Auditor Elaine Howle to conduct an audit of Medi-Cal to find out why the backlog exists. State Senator Richard Lara (D-Bell Gardens), whose committee asked for the audit, said, “Just because we want to give millions of people medical insurance and cards doesn’t necessarily mean they’re going to be able to receive services.”

While she’s at it, maybe Howle can explain the growing number of people insured through Covered California who are suddenly, and without explanation, being transferred to Medi-Cal. It is suspected that people are being bumped down because the state has decided they make too much money to qualify for Covered California, where the care is considered superior.

–Ken Broder


To Learn More:

Advocacy Groups File Lawsuit over Medi-Cal Backlog (by Anna Gorman, Kaiser Health News)

Medi-Cal Patients Sue over Application Backlog (by Judy Lin, Associated Press)

Medi-Cal Obamacare Applicants Sue over Monthslong Delays (by Susan Abram, Los Angeles Daily News)

Patients Sue State over Backlog of Medi-Cal Approvals, Now at 350,000 (by Eryn Brown, Los Angeles Times)

Medi-Cal Patients Can’t Find Doctors; State Needs Audit to Find out Why (by Ken Broder, AllGov California)

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