California DHCS, HHSA faces discrimination suit over Medi-Cal

Advocates have filed a discrimination suit against California’s Health and Human Services Agency and California’s Department of Health Care Services, alleging that Medi-Cal violates enrollees’ civil rights.

The suit was filed by the Mexican American Legal Defense and Educational Fund, the Civil Rights Education and Enforcement Center, and the law firm of Feinberg, Jackson, Worthman & Wasow LLP on behalf of five individuals, St. John’s Well Child & Family Center, SEIU-United Healthcare Workers West, and National Day Laborer Organizing Network.

The suit alleges that Medi-Cal enrollees are denied access to timely care due to low reimbursement rates, resulting in a lack of providers willing to treat Medi-Cal patients, as a result “Medi-Cal participants suffer from greater pain, illness, and undiagnosed and untreated serious medical conditions—with significant impact to their overall health—than do their fellow Californians with other insurance.”

The suit further alleges that Latinos are disproportionally affected as the largest group of Medi-Cal enrollees.

Bill Lann Lee, senior counsel of the Civil Rights Education and Enforcement Center (CREEC), and a former assistant attorney for civil rights at the U.S. Department of Justice, said in a statement:

California is required by law to provide Medi-Cal health insurance participants access to healthcare equivalent to the access of people with other insurance coverage, including employer-sponsored insurance and Medicare. In the past, when Medi-Cal was a predominately white program, access was better because the reimbursement rates were closer to other insurance reimbursement rates. That changes when the Medi-Cal program became increasingly Latino and then majority Latino. This is discrimination.

According to MALDEF, there were 2.3 million Latinos enrolled in Medi-Cal in 2000. In 2016, that number had more than tripled to 7.2 million. During that time frame, reimbursement rates fell 20 percent compared to Medicare.

Medi-Cal reimbursement rates are among the lowest in the country. The lawsuit seeks an increase in reimbursement rates and more state oversight to ensure improved access to care.

“Medi-Cal is a critical program to so many of California’s children and adults,” said Thomas Saenz, MALDEF president and general counsel. “It is no exaggeration to say that our current and future workforce – our very prosperity as a state – depends on Medi-Cal providing access to vital physician care. We must ensure that Medi-Cal is administered in a fair and non-discriminatory manner that serves the healthcare needs of Latinos and all others enrolled in the program.”

In 2015, the same groups filed a complaint with DHHS calling for a federal investigation of Medi-Cal, but the department did not launch an investigation. In a letter responding to the 2015 complaint, Attorney General Kamala Harris wrote:

To the extent that you claim that Medi-Cal reimbursement rates discriminate against Latinos, there is no evidence of any such discrimination, nor are the claims articulated in your letter legally cognizable. You have not alleged, and we are not aware of, any evidence that Latino beneficiaries are being treated differently that other beneficiaries under the Medi-Cal program.

The letter also states that the Department of Health Care Services’ monitoring of Medi-Cal does not show “any systemic problems with patient access to services” and that current reimbursement rates comply with federal requirements.