Judge Gives Green Light to Civil Rights Lawsuit Affecting 1 in 3 Californians

[June 25, 2019] LOS ANGELES – The Alameda County Superior Court has ruled that a major civil rights lawsuit over inadequate access to health care for 13 million Medi-Cal participants may proceed, despite a two-year fight by the State of California to stop its advancement.

The ruling, in an order posted yesterday by Judge Winifred Smith, means the State of California cannot further delay the lawsuit, which advocates filed in July 2017. The lawsuit alleges that the Department of Health Care Services (DHCS), which is responsible for administering Medi-Cal, the Medicaid health insurance program for low-income Californians, has discriminated against Medi-Cal’s disproportionately Latino participants by disinvesting from the program over the last 40 years as the Latino share of enrollment surged. This has resulted in rates so low that many doctors won’t accept Medi-Cal patients. In addition, DHCS fails to monitor or enforce access requirements and puts in place various administrative barriers to accessing care.

“Eligibility to receive care and access to needed care have unfortunately become two different things in the prosperous state of California; this development continues to harm too many Latinos and other Medi-Cal recipients,” said Thomas A. Saenz, MALDEF president and general counsel. “We look forward to this court action catalyzing necessary change in our thriving state.”

Judge Smith ruled that the plaintiffs sufficiently stated claims for disparate impact and intentional discrimination under state law, as well as violation of the substantive due process clause of the California constitution, and thus overruled objections filed by several state defendants, including DHCS.

Currently, California’s reimbursement rates are so low that they discourage participation by healthcare providers and leave Medi-Cal participants with few options. 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 travel long distances, effectively denying them meaningful access to care. For example, one of the Plaintiffs has cerebral palsy and is semi-paraplegic but had to wait over 18 months to get an appointment with a neurologist despite suffering from grand mal seizures.

“This lawsuit exposes the way the state of California treats a third of its population by paying such low rates to health providers that people suffer unnecessarily because they cannot get the timely healthcare they need,” said Dave Regan, president of the Service Employees International Union – United Healthcare Workers West. “We’re confident this lawsuit will put an end to the practice of treating people who get their healthcare through Medi-Cal like disposable, second-class citizens.”

The complaint describes how the state’s disinvestment is racially linked: As the Latino share of enrollment more than doubled since 1979 from approximately 25 percent to nearly 60 percent of all Medi-Cal patients, reimbursement rates have dropped 40 percent, from 125 to 76 percent of the national average for all Medicaid programs, leaving Medi-Cal 48th or 49th of all state programs in physician reimbursement. Moreover, at the same time that Medi-Cal physician reimbursement rates – which serve a disproportionately Latino population – have steadily declined, Medi-Cal long-term care reimbursement rates – which serve a disproportionately white population – have steadily increased.

Counsel on the lawsuit include MALDEF, CREEC (the Civil Rights Education and Enforcement Center) and the law firm of Feinberg, Jackson, Worthman & Wasow LLP. They filed it on behalf of St. John’s Well Child & Family Center, the Community Division of SEIU-United Healthcare Workers West (SEIU-UHW), the National Day Laborer Organizing Network (NDLON), and several individual Medi-Cal participants.

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