Coalition calls for federal investigation of Medi-Cal reimbursement for alleged discrimination
A coalition of civil rights advocates Tuesday called for a federal investigation of California's Medicaid program, alleging that it discriminates against millions of low-income Latinos by denying them equal access to healthcare.
The group claimed that Medi-Cal, California's health program for the poor, reimburses doctors in the program so poorly that many won't treat enrollees, leaving Latino beneficiaries to face lengthy delays and denials for care. In a civil rights complaint filed Monday with the U.S. Department of Health and Human Services, advocates asked the federal government to order Medi-Cal to raise reimbursement rates so that Medi-Cal enrollees would have the same access to care as people covered by Medicare and employer-sponsored health plans.
More than 12.5 million Californians receive health care through Medi-Cal, the state's version of Medicaid. Nearly two-thirds are Latino. The program, which is funded with both federal and state dollars, has seen tremendous growth under the Affordable Care Act and now serves about a third of the state's residents.
According to the complaint, the percentage of Latinos in Medi-Cal has increased as reimbursement rates for providers have decreased. It cited provisions of the federal Civil Rights Act and the Affordable Care Act prohibiting discrimination by federal health programs and activities that receive federal funding.
The state has among the lowest Medicaid reimbursement rates in the nation, according to the complaint.
"By ensuring that reimbursement rates remain unduly low, the state of California has engaged in unlawful discrimination under both federal and state law," said Thomas Saenz, president and general counsel of the Mexican American Legal Defense and Educational Fund, or MALDEF.
Jennifer Kent, director of the California Department of Health Care Services, said in a statement she could not comment on the specifics of the complaint but that the department closely monitors access in its Medi-Cal program. Kent said she and the department "work hard to serve all Medi-Cal beneficiaries equally" and partner with plans, counties and others to provide timely access to healthcare.
The civil rights action is the latest effort in a campaign involving lawsuits and lobbying by advocates and doctors to increase payments in the Medi-Cal. Many providers have claimed they cannot afford to take Medi-Cal patients.
The federal complaint includes three named Medi-Cal beneficiaries, one a 61-year-old man who struggled to find a surgeon to repair his hernia and another, a 31-year-old man with cerebral palsy who had to wait 1 ½ years to see a neurologist.
Other Latino Medi-Cal beneficiaries gathered at the offices of MALDEF on Tuesday said they, too, have had difficulties.
Norma Gaytan, 34, said she has encountered frustrating delays getting appointments with specialists to diagnose and treat her stomach problems. Gaytan said she had to wait for about a year before getting a colonoscopy and finally getting a diagnosis of diverticulitis.
"If I was to have a different kind of insurance, maybe things would have been better," said Gaytan, a single mom from East Los Angeles. "Maybe I would have been seen more quickly."
Marta Contreras, 66, said she has also had problems getting her disabled son the care he needs through Medi-Cal. Earlier this year, 23-year-old Jose Manuel Contreras was having trouble urinating and was referred to a urologist.
But the specialist was more than 40 miles away and she didn't have transportation. Marta Contreras said she hadn't even heard of the city where the doctor was located.
"It's frustrating," she said. "Why would they send us so far?"
Abbi Coursolle, a staff attorney at the National Health Law Program, which participated in filing the complaint, said that her organization regularly helps people dealing with such access problems. But, she said, "You shouldn't have to call a lawyer to see a doctor," she said.
The Mexican American Legal Defense and Educational Fund, the National Health Law Program, the Civil Rights Education and Enforcement Center were among the groups filing the complaint.
The Office of Civil Rights within the U.S. Department of Health and Human Services has six months to investigate the claim, said Bill Lann Lee, senior counsel with the Civil Rights Education and Enforcement Center. The office could refer it to the Department of Justice for enforcement or legal action, he said.
Blue Shield of California Foundation helps fund KHN coverage in California.
The California Wellness Foundation supports KHN's work with California ethnic media.
Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.
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