By Anna Gorman
Fri, Jan 23 2015
Medi-Cal applicants who have been waiting for more than 45 days can receive temporary health benefits while officials determine eligibility for the public insurance program, a state Superior Court judge ruled this week.
The decision came in a lawsuit filed in September alleging that a large backlog of applications to California’s Medicaid program left hundreds of thousands of people unable to access health care.
“The ruling is absolutely vital in ensuring benefits for everyone who is entitled to them,” said Cori Racela, an attorney with Neighborhood Legal Services of Los Angeles County. “They may have medical needs while they are waiting for their application to be processed.”
The suit, which was filed in Alameda County Superior Court by a coalition of health advocates and legal services groups, cited delays in enrolling pregnant women, children and adults with life-threatening conditions.
Advocates said many either had to postpone treatment or pay cash to see doctors.
In one case cited in the suit, a man died of a pulmonary embolism while awaiting the outcome of his Medi-Cal application. His approval notice didn’t arrive until two months after his death.
His mother, Frances Rivera, said she was thrilled that the people who need Medi-Cal can get it in a timely way. “Hopefully somebody’s life will be saved because of this decision,” she said in a written statement.
In the Jan. 20 ruling, Alameda County Superior Court Judge Evelio M. Grillo ordered the state Department of Health Care Services to make timely determinations on the Medi-Cal applications. Grillo ruled that applicants who are likely to be eligible for benefits but whose cases have not been decided within 45 days can receive provisional benefits. The judge also ordered the state to notify applicants that they have a right to an administrative hearing on their eligibility.
“It is clear that the Department has failed to comply with the timeliness standard for making eligibility determinations to the irreparable harm of Petitioners and many others,” Grillo wrote.
Medi-Cal is California’s version of Medicaid, the publicly funded insurance program for poor and disabled residents. Prompted by the Affordable Care Act, California expanded Medi-Cal last year to include those without children and those with higher incomes.
source : Judge Orders California To Make Timely Decisions On Medicaid Coverage
