Lawsuit Seeks to Block Expulsion of 1 Million from Medi-Cal Rolls

Wednesday, November 19, 2014

Stories about Medi-Cal enrollment generally revolve around the huge numbers of new enrollees signed up in California’s version of federal Medicaid as part of the Affordable Care Act, otherwise known as Obamacare. The rolls would swell to 11.3 million with the addition of 2.7 million new low-income members under the program’s broader criteria.

But the Act also dictated changes to Medi-Cal that required its current users to renew their membership in an unfamiliar, and perhaps, more demanding way. As a result, renewals are way down and estimates are that more than 1 million people will be bumped from the rolls.

Normally, around 70% of Medi-Cal beneficiaries send in their renewals, according to the California Department of Health Care Services (DCHS). This year, the percentage is hovering above 50%. “The response rate has not been as good as we want,” DHCS Director Toby Douglas told California Healthline.

It also wasn’t as good as the Western Center on Law & Poverty wanted. They filed a lawsuit in Alameda County Superior Court against the DHCS Monday along with other advocacy groups, alleging that beneficiaries were being unfairly booted.

Language is one of the barriers. “Most of our clients are limited English proficiency,” health programs coordinator Connie Lo told Kaiser Health News. “They don’t even know what these packets are for and why they’re receiving so many documents together that they can’t even read.” The new forms are just in Spanish and English.

But Cori Racela, a staff attorney at Neighborhood Legal Services of Los Angeles County, said it wasn’t just a language problem. “It’s a very confusing form even in English, and it looks very different from what it looks in past years,” she said.

Jen Flory, a senior attorney at the Western Center on Law & Poverty, more than implied that the problems were a calculated move by the state. “When people fail to jump through these hoops to stay on the program, the state saves money,” she said. The federal government pays 100% of the costs for Californians who join Medi-Cal for the first time using Obamacare’s broader enrollment rules, but only 50% for those already on the rolls.

The lawsuit seeks a temporary injunction to stop California from dropping people from Medi-Cal until a better system can be put in place to ensure that beneficiaries have been properly informed.

DHCS official Rene Mollow told Kaiser Health News the agency knows the form is in need of improvement, but for now, “We do have remedies in place where people can come back into coverage” after they lose their insurance.  

–Ken Broder


To Learn More:

California Expected to Drop Hundreds of Thousands from Medi-Cal Rolls (by Jenny Gold, Kaiser Health News)

DHCS Faces Legal Action Again over Medi-Cal Coverage Cancellations (by JJ Lee, State of Reform)

Medi-Cal Enrollment Jumps to 11.3 Million (by David Gorn, California Healthline)

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