Binsfeld, who suffers from lupus, waited 10 months to see a rheumatologist (she’s supposed to see one every four months), and a year to see an ophthalmologist (she’s supposed to go every six months, to check for blindness associated with her medications). The delays in care led to several lupus flares, episodes during which Binsfeld experiences extreme fatigue, pain in her joints, and headaches. Repeated flares can cause organ damage or kidney disease.
“I just want better health care. I want to be able to call the doctor if I’m not feeling well and to be able to be seen,” Binsfeld says. “I want everybody else on Medi-Cal to be treated the same as those that have private insurance.”
The lawsuit alleges several shortcomings in the Medi-Cal program that lead to these delays, namely “extremely low” reimbursement rates and burdensome paperwork that forces doctors to limit the number of low-income patients they see.
“As the number of Latinos has grown in the program, the state has cut funding,” says Darin Ranahan, an attorney from the Oakland law firm Feinberg, Jackson, Worthman and Wasow, representing the plaintiffs. “Simply put, if you disinvest from a program as it’s coming to serve more and more people of color, that’s a form of race discrimination.”
The state is also failing to adequately monitor the program and ensure that patients are being seen in a timely manner, Ranahan says. For example, state regulations require patients to get urgent care within 48 hours, primary care within 10 days, and specialty appointments within 15 days.
“What we’ve seen, repeatedly, is people on Medi-Cal are not able to get appointments within these times,” Ranahan says.
The state Department of Health Care Services countered, saying it routinely monitors patient access to care in the Medi-Cal program, and that neither the state, nor federal health officials, had identified any systemic problems.
Beyond that, the state said it's position on the allegations was outlined in a letter the state attorney general wrote last year, after health advocates and union representatives from SEIU filed a similar complaint with the U.S. Department of Health and Human Services Office for Civil Rights in December 2015.
The letter says the state's reimbursement rates have been thoroughly reviewed and approved by federal officials, and that rates are uniform for all providers and patients. It says Latino beneficiaries are treated the same as all Medi-Cal beneficiaries.
“We work hard to serve all beneficiaries equally,” Jennifer Kent, director of the Department of Health Care Services, said in a 2015 statement responding to the original complaint. “We are committed to serving all vulnerable populations with vital health services.”
The department also cited a January 2015 survey by the Blue Shield of California Foundation that showed satisfaction gaps between whites and Latinos, which were identified in 2011, have been eliminated or dramatically narrowed. Overall satisfaction with Medi-Cal was 90 percent.
Federal officials did not act on the original complaint, and advocates say that’s why they are now filing the lawsuit directly against the state.