Clinics Battle State for Medi-Cal Patients

OAKLAND, Calif. (CN) - Community clinics squared off against California in a Tuesday hearing on whether the state can terminate coverage for "hundreds of thousands" of Medi-Cal patients.

The Korean Community Center of the East Bay and Los Angeles' Korean Resource Center sued the California Department of Health Care Services in November in Alameda County Court.

On Tuesday, the clinics' attorneys told Judge Evelio Grillo that "fundamental legal problems" must be resolved before Medi-Cal can terminate benefits for hundreds of thousands of beneficiaries.

The clinics claimed:

that the state sent English-only materials to hundreds of thousands of Medi-Cal recipients who could not read or complete the "redetermination of Medi-Cal eligibility" forms;

that the notices failed to inform people about their "right to cure," i.e., re-establish Medi-Cal eligibility;

and that the state failed its legal duty "to keep people on benefits using all known information about them, without requiring them to submit the information on the prescribed forms."

The renewal process was changed this year to align with expanded Medi-Cal eligibility under the Affordable Care Act. Medi-Cal is California's Medicaid program.

The clinics asked that the 2015 Medi-Cal redetermination process not proceed if it contains the same flaws as the 2014 process.

Clinics' attorney Corilee Racela told the court that not all of the Medi-Cal renewal paperwork informs beneficiaries of the 90-day cure period, during which they can re-establish eligibility.

Deputy attorneys general Hadara Stanton and Susan Carson, representing the state, responded that Racela provided no evidence of harm arising from beneficiaries' ignorance of the cure period. Stanton said that the state could not be held responsible for beneficiaries' failure to follow up on termination notices.

"It is undisputed that a system that provides health care to 11 million individuals is going to have glitches," Stanton said. "But there is no evidence of any statewide systemic issue causing harm."

But Racela cited the problem with English-only forms, and said the state wrongfully required aged, disabled and blind beneficiaries to provide tax household information, which they are exempt from providing.

Racela said these problems cause "massive harm, and to people who can bear that harm the least."

"There's a serious problem in moving forward with a process that has known, grave flaws that are very fixable," Racela said.

Given the burden those flaws place on low-income people, Racela said, an injunction is "absolutely appropriate."

Stanton and Carson insisted that there is no evidence of a systemic Medi-Cal problem. They said the plaintiffs provided only a series of unrelated individual issues.

Racela responded that the differing experiences of the affected beneficiaries "is actually indicative of how profound the problem is."

"The redetermination law is designed to provide safeguards to low-income beneficiaries," she said. "These beneficiaries did not get the safeguards that they were entitled to."

The state's attorneys said the petitioners had not given them enough time to respond to the allegations that petitioners submitted late Friday.

Judge Grillo gave the state until Dec. 19 to respond to the petitioners' new allegations.

"This request for an injunction is pretty significant," Grillo said. "I have to be careful what I do here."

He set another hearing for Dec. 23.

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