Lawsuit: California Medicaid Backlog Causes Patients to ‘Suffer’

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Lawsuit: California Medicaid Backlog Causes Patients to ‘Suffer’

Nina Liss-Schultz

The massive backlog in California Medicaid applications has left low-income patients “suffering” and unable to receive care, according to a lawsuit filed against the state.

The massive backlog in California Medicaid applications has left low-income patients “suffering” and unable to receive care, according to a lawsuit filed against the state Wednesday.

The suit, filed by health access advocates, charges that the backlog violates state law.

As Rewire has reported, following the expansion of Medi-Cal—California’s version of the federal Medicaid program—more than one million residents, many of them previously ineligible and uninsured, signed up for the government-funded insurance. But the unprecedented influx of applications has backlogged the system; many residents are still waiting for both final confirmation and their Medi-Cal insurance card.

In May, more than 900,000 applications had yet to go through the review process, which requires verification of eligibility. The number of applications in purgatory decreased after the Centers for Medicare and Medicaid Services sent a letter to six states, including California, warning that they were falling behind and asking them to come up with a plan for how to trim their backlogs.

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Still, as many as 350,000 applications remain in limbo here.

California law mandates that the state’s Department of Health Care Services (DHCS) review Medi-Cal applications and send written notice of eligibility status to patients within 45 days of when the application was submitted.

Some residents have been waiting since the end of 2013, according to the lawsuit.

Robert Rivera, whose experience is detailed in the case, submitted his Medi-Cal application in early January 2014. Rivera, who suffered from gallstones and other chronic conditions including heart problems, died of a pulmonary embolism four months later, still uninsured. According to the lawsuit, Rivera never heard from the state Department of Health Care Services about his application, instead going to the emergency room for services he needed.

The DHCS in June finally sent a notice granting Rivera Medi-Cal benefits, six months after his application submission and two months after his death.

“By definition, Medi-Cal applicants are among California’s poorest residents and have no alternate means to pay for treatment for urgent, critical health care needs,” reads the suit. “Many of the applicants in this Medi-Cal backlog are sick or have serious chronic health conditions and urgently need medical care or prescription medications.”

The lawsuit also describes the experiences of several other Californians, many of whom avoid going to hospitals or clinics while their coverage is still pending, even when they face serious health risks.

In California, the DHCS is required to grant Medi-Cal to certain residents before completing the application review process, allowing those patients to seek care before their application has been fully processed and they’ve received their insurance card.

The lawsuit alleges that the DHCS is delaying these benefits and not notifying applicants that they can start receiving services, thus violating the law.

“There are still 350,000 applicants in the backlog. These are not just numbers. These are real people, and they are suffering,” said San Francisco attorney Lucy Quacinella in a statement. “The state has decided it’s OK to leave them in limbo, allowing their health to deteriorate as they wait desperately for word about their Medi-Cal applications. It’s not OK—it’s illegal.”