Health

Health advocates sue California over Medi-Cal backlog

California experienced a surge of new applications for Medi-Cal under the Affordable Care Act. But processing of those applications has been plagued by delays. On Wednesday, health advocates sued the state to try to speed it up. (Photo by Justin Sullivan/Getty Images)
California experienced a surge of new applications for Medi-Cal under the Affordable Care Act. But processing of those applications has been plagued by delays. On Wednesday, health advocates sued the state to try to speed it up. (Photo by Justin Sullivan/Getty Images)
Justin Sullivan/Getty Images

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Health advocates have sued California over its persistent backlog of pending Medi-Cal applications, alleging that the state has illegally forced hundreds of thousands of low-income residents to go without health insurance for months. The suit also claims that in some cases people have had to forego urgent medical treatment while they wait for their applications to be approved.

By law, the state's Department of Health Care Services is required to process applications for Medi-Cal - the state health insurance program for poor Californians - within 45 days. But hundreds of thousands of applications have sat around longer than that, many for nine months or more.

California experienced a huge surge in the number of new applications for Medi-Cal beginning in January, when the Affordable Care Act expanded eligibility for the program.

The state’s computer systems were ill-prepared to handle the surge, and at one point there were nearly a million applications pending. The Department of Health Care Services has since reduced the backlog to about a third of that number, but the groups that filed the suit say that’s not good enough.

"We feel that [state officials] do not understand that people who have heard nothing from the state are still being harmed because they don’t have access to Medi-Cal," said Jen Flory of the Western Center on Law and Poverty, one of the attorneys who filed the suit on behalf of several affected clients.

The lawsuit alleges that one of those people is Robert Cribbs, a 48-year-old Visalia resident. According to the suit, Cribbs had health problems, including gallstones, chest pains and finger numbness that went untreated because he lacked insurance. He also suspected he had heart disease because it ran in his family. In January, Cribbs applied for coverage through the state health exchange, Covered California, and because of his low income, had his application referred to Medi-Cal.

While he waited to be approved, his health worsened, his mother, Frances Rivera, said in a signed affidavit. Her son visited ERs but got limited treatment, she said. In April, Cribbs died from a pulmonary embolism

Seven weeks later, a letter arrived for Cribbs saying he’d been approved for Medi-Cal, more than five months after he applied.

"It was like a knife stuck in my heart," Rivera said in an interview, adding, "why couldn’t this have happened four months ago?"

Rivera said she agreed to be named in the lawsuit because she wants to help others avoid her son's fate.

"There’s a lot of people out here that are in the same situation that we were, going through the same mental anguish, heartache, watching their loved ones suffer," she said.

The lawsuit, filed in Alameda Superior Court, asks a judge to force the state to meet the 45-day processing deadline for all Medi-Cal applications.

It also asks that the state be required to approve new Medi-Cal applications on a temporary basis while it verifies an applicant’s income, and to notify applicants of their right to an administrative hearing in the event that their application stretches for longer than 45 days. The groups behind the lawsuit had previously recommended granting presumptive eligibility to all applicants who had been waiting more than 45 days, but in July the state rejected the idea.

In an email, Department of Health Care Services spokesman Norman Williams said the agency does not comment on pending litigation. But he said the state continues making progress on clearing the backlog. He said that from mid-July to mid-August, it cut its backlog by about 250,000 applications. As of mid-August, 350,000 applications had been pending for more than 45 days, he said.

"Since then, many of those applications have been processed," he wrote in the email. "We are currently developing an updated set of numbers to reflect that activity."