Court Puts an End to Medi-Cal Limbo and Orders State to Issue Timely Healthcare Benefits

Court Puts an End to Medi-Cal Limbo and Orders State to Issue Timely Healthcare Benefits

Low-income applicantsincluding children, pregnant women, and people with life-threatening illnesseswill no longer have to wait for months while their health deteriorates

OAKLAND, CA—If California is unable to determine whether an applicant is eligible for Medi-Cal within 45 days, it must grant that applicant temporary health benefits, ruled the Alameda County Superior Court. The January 20 ruling marks a major victory for low-income Californians, many of whom had been stuck in a kind of Medi-Cal limbo while their health deteriorated.
Frances Rivera, a plaintiff in the case whose son died while waiting a decision on his Medi-Cal application, said she is relieved to hear other families will be spared the same misfortune.

“I am just thrilled that the people who need Medi-Cal will be able to get it in a timely manner,” she said. “Hopefully somebody’s life will be saved because of this decision.”

Two months after her son died of a pulmonary embolism—and seven months after he submitted his application—Rivera received a letter stating he qualified for Medi-Cal, and that his coverage would apply retroactively.

The ruling orders the California State Department of Health Care Services to grant provisional benefits to applicants who are likely eligible and whose applications have not been decided within 45 days—the legal time limit for making most Medi-Cal eligibility decisions. Others must still be notified within 45 days that they have a right to an administrative hearing to get a decision on eligibility.

“After the lawsuit was filed and right before a court hearing, the state managed to bring down the backlog numbers, showing that a remedy was well within the state’s control all along,” said Michael Keys of Bay Area Legal Aid. “The ruling protects hundreds of thousands of new Medi-Cal applicants from the specter of a new backlog building back up to the 900,000 heights we saw last spring.”

The lawsuit, filed September 17, 2014, accused the State of California of leaving hundreds of thousands of low-income applicants to wait for months without the healthcare they desperately needed and lawfully deserved. It was brought by a coalition of legal services organizations and community healthcare advocates, including Bay Area Legal Aid, Central California Legal Services, Multiforum Advocacy Solutions, National Health Law Program, Neighborhood Legal Services of Los Angeles County, and Western Center on Law & Poverty.

Thousands of eligible applicants are still in the backlog and are entitled to relief under the Court’s order. Medi-Call applicants who have been waiting more than 45 days for a Medi-Cal eligibility determination should contact the Health Consumer Alliance for assistance at 1-888-804-3536.

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Organizational Information and Press Contacts

Multiforum Advocacy Solutions
Contact Lucy Quacinella, attorney: (415) 407-5386
Multiforum Advocacy Solutions, founded by Lucy Quacinella, is a private firm based in San Francisco that specializes in health and other public benefits programs and related international human rights.

Central California Legal Services
Contact Gillian Sonnad, attorney: (559) 570-1238
Central California Legal Services is a non-profit law firm. We provide free legal assistance to low income families and individuals in the following counties: Fresno, Kings, Mariposa, Merced, Tulare, and Tuolumne.

Neighborhood Legal Services of Los Angeles County
Contact Cori Racela, attorney: (323) 346-5065
Neighborhood Legal Services of Los Angeles County (NLSLA) is one of California’s most prominent public interest law firms. Each year NLSLA provides free assistance to more than 100,000 individuals and families through programs that expand access to justice for the poor and address the most critical needs of Los Angeles’ poverty communities.

Western Center on Law and Poverty
Contact Jen Flory, attorney: (916) 282-5141
Since 1967, Western Center on Law and Poverty has led the fight in California’s courts, counties and capital to secure housing, healthcare and a secure safety-net for low-income children, women and men. Western Center’s attorneys and advocates are the impact litigation lawyers for the poor and their voice in Sacramento.

Bay Area Legal Aid
Contact Michael Keys, attorney: (415) 354-6339
BayLegal’s mission is to provide meaningful access to the civil justice system through quality legal assistance regardless of a client’s location, language or disability.

National Health Law Program,
Contact Kimberly Lewis, attorney: (310) 204-6010, ext. 108
Founded in 1969, the National Health Law Program (NHeLP) protects and advances the health rights of low-income and underserved individuals and families. The oldest nonprofit of its kind, NHeLP advocates, educates and litigates at the federal and state levels.

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