In Federal Complaint, Advocates Allege Medi-Cal Violates Latinos' Civil Rights

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Health advocates are accusing state officials of discriminating against Latino patients in Medi-Cal, the state’s health insurance program for people who are low income.

They filed a complaint with the U.S. Department of Health and Human Services Office for Civil Rights, arguing reimbursement rates are so low that doctors refuse to see Medi-Cal patients -- nearly two-thirds of whom are Latino. Many patients face long waits for care or outright denial, the complaint says.

One of them is Saul Jimenez, who has cerebral palsy and epilepsy. He gets terrible seizures that land him in the ER. His mother, Analilia Jimenez Perea, has been trying to get him to see a neurologist. But with Medi-Cal, she says the wait is a year and a half.

"It’s very sad when I try to get an appointment for him at a special clinic," Jimenez Perea said in videotaped remarks. "They so happy to answer me until they ask me what is insurance. And I say, 'Medi-Cal.' They say, 'We just don’t accepting Medi-Cal,' or, 'You have to be on the waiting list,' or, 'No thank you.'"

Maria Barba has had similar difficulties getting treatment for kidney stones. She’s been to two different ER’s with incredible pain.

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"They all tell me the same thing," Barba said in Spanish, through an interpreter, "that I need a surgery and they won't do it. When I tell them I have Medi-Cal, they tell me they won't see me."

Lawyers from the Mexican American Legal Defense and Education Fund and the National Health Law Program say the state is abdicating its responsibility to provide equal access to health care.  They allege that Medi-Cal reimbursement rates have fallen "in tandem" with the increasing proportion of Latinos in Medi-Cal.

“By ensuring that reimbursement rates remain unduly low, the state of California has engaged in unlawful discrimination under both state and federal law,” said Thomas Saenz, president and general counsel for MALDEF.

Here's more from the complaint:

Today, no other type of health insurance in California covers a population that is so heavily Latino. The separate and unequal system of healthcare thus violates the protections of Title VI of the Civil Rights Act and the Department of Health and Human Services’ implementing regulations, as well as Section 1557 of the Affordable Care Act ...

State Medi-Cal officials said they would not comment on the specifics of the complaint, but insisted that they closely monitor access to all Medi-Cal programs.

“We work hard to serve all beneficiaries equally,” Jennifer Kent, director of the Department of Health Care Services, said in a statement. “We are committed to serving all vulnerable populations with vital health services.”

The statement cited a January 2015 survey by the Blue Shield of California Foundation that showed satisfaction gaps between whites and Latinos, identified in 2011, have been eliminated or dramatically narrowed. Overall satisfaction with Medi-Cal was 90 percent.

Catha Worthman, an attorney with the Oakland law firm Feinberg, Jackson, Worthman and Wasow, says the Office of Civil Rights has a duty to investigate the claims, and, if they agree with the advocates that the law has been violated, they can negotiate a solution with California health officials. Advocates believe that solution should include raising reimbursement rates and better monitoring of access to doctors.

If no resolution is reached voluntarily, the Office of Civil Rights can ask the federal Department of Justice to bring a lawsuit or the complainants could file a class action lawsuit on behalf of all Latino Medi-Cal recipients.

H.D. Palmer, spokesman for the state Department of Finance, said Gov. Jerry Brown is currently working on a budget he will submit to the Legislature in January.

“We have not said we’re opposed to rate increases, but if you’re going to have a rate increase, show us how that results in an expansion of care,” Palmer said.