A lawsuit filed Wednesday alleges that California provides unequal medical care to the 13.5 million people, including 7.2 million Latinos, who are enrolled in Medi-Cal, the health insurance program for low-income residents.
The suit, which was filed in Alameda County Superior Court, says Medi-Cal patients face obstacles in getting timely access to care because the state pays providers so little for their services that many doctors decline to accept Medi-Cal patients.
It claims those problems are compounded by the state’s failure to adequately monitor and oversee the program.
The suit alleges:
“In effect, California has created a separate and unequal system of healthcare, one for the insurance program with the largest proportion of Latinos (Medi-Cal), and one for the other principal insurance plans, whose participants are disproportionately white.”
Speaking at a news conference on the steps of the Rene C. Davidson Courthouse in Oakland, Miranda Galindo, a staff attorney with the Mexican American Legal Defense and Educational Fund (MALDEF), said the firm represents clients:
“… who are representative of people who are being irreparably harmed as a consequence of this broken system.”
“This is a Latino civil rights issue because at the same time as the number and proportion of Latinos surged in Medi-Cal the amount of the rates at which doctors are reimbursed continuously dropped. … This disinvestment in Medi-Cal as the program became overwhelmingly Latino created a broken, second-class system of health insurance.”
MALDEF, the Civil Rights Education and Enforcement Center and the law firm of Feinberg, Jackson, Worthman & Wasow LLP filed the suit on four individual plaintiffs as well as the St. John’s Well Child & Family Center in South Los Angeles, Service Employees International Union-United Healthcare Workers West and the National Day Laborer Organizing Network.
The defendants in the suit are Diana Dooley, the secretary of the California Health and Human Services Agency, Jennifer Kent, the director of the California Department of Health Care Services, and both of those agencies.
The suit alleges that because Medi-Cal reimbursement rates are much lower than Medicare and employer-sponsored insurance rates, they discourage participation by healthcare providers and leave Medi-Cal recipients with few options.
And because there are only a few Medi-Cal providers, patients are frequently unable to find the primary and specialty care they need, according to the suit.
California Department of Health Care Services spokeswoman Carol Sloan said in a statement that the agency:
“… has not identified any systemic problems with patient access to services in the Medi-Cal program nor has the federal Centers for Medicare and Medicaid Services identified any issues.”
Sloan also provided a letter that state officials sent to the plaintiffs’ lawyers last year saying there is no evidence of discrimination against Latinos.
The suit says Medi-Cal pays doctors about half of what they’d get through Medicare, the government-run health insurance for people over 65.
It says that off the 50 states, California’s reimbursement rates to health providers for services to low-income people ranks 49th.
Esther Castaneda, 56, of Sacramento, a Medi-Cal beneficiary who’s one of the plaintiffs in the suit, said she had to wait a year to get her gallbladder removed because she couldn’t get appointments with her doctors or referrals for surgeons who took Medi-Cal.
Castaneda said she stopped eating to minimize the extreme pain and vomiting she’d experience otherwise and eventually resorted to getting the surgery in Mexico, where a doctor told her she would’ve died without it.
The lawsuit doesn’t seek any financial damages but asks that the state pay doctors enough to ensure that Medi-Cal beneficiaries can receive medical care of similar quality to others in the state and that there are enough doctors who will take Medi-Cal patients.