OAKLAND, Calif. (CN) — Medi-Cal recipients and a major union sued California’s top health care officials in a class action Wednesday, accusing them of steadily cutting spending on the state’s health insurance program as the number of Latino Medi-Cal enrollees surged in the past two decades.
The lead plaintiffs, Analilia Jimenez Perea and her disabled son, were joined by the Service Employees International Union — United Healthcare Workers West, California’s largest health care worker union, the National Day Laborer Organizing Center, St. John’s Well Child and Family Center, and three other named plaintiffs.
They say the state began reducing Medi-Cal reimbursement rates to doctors as the percentage of Latino Medi-Cal patients rose between 2000 and 2016, to more than half of all enrollees.
Because Medi-Cal pays half of what Medicare pays for the same procedures — down from 65 percent in 2000 — doctors will not treat Medi-Cal beneficiaries, according to the complaint filed in Alameda County Superior Court.
So Medi-Cal’s predominantly Latino patients wait weeks or months for an appointment compared to their white counterparts, who are disproportionately covered by more generous Medicare and employer-sponsored insurance plans, the plaintiffs say.
The law requires California to provide Medi-Cal patients with the same access to care, and the plaintiffs claim the doctor shortage created by low reimbursements violates state anti-discrimination laws and the California Constitution.
“This disinvestment in Medi-Cal as the program became overwhelmingly Latino created a broken second-class system of Medi-Cal, of health insurance, where there are over 7 million Latinos depending on too few doctors willing to treat them,” their attorney Miranda Galindo said at a news conference Wednesday after the lawsuit was filed. Galindo is a staff attorney with the Mexican American Legal Defense and Educational Fund in Los Angeles.
It is estimated that 13 million Californians, 7.2 million of them Latino, are enrolled in Medi-Cal, California’s Medicaid program. The program covers low-income adults and families, seniors, people with disabilities, pregnant women and children in foster care: more than one-third of the state population.
In some counties, such as Tulare and Merced in Central California, more than 50 percent of residents were enrolled in the program in September 2015, according to the Department of Health Care Services, which is named as a defendant.
Medi-Cal patients are more likely to have trouble finding care and have their insurance coverage rejected by a provider, according to the complaint. It says that from 2013 to 2015, 24 percent of enrollees could not get an appointment within two days for an illness or injury, compared to 9 percent of Medicare patients and 8 percent of patients with employer-sponsored insurance.
Because of the difficulty of finding a doctor, Medi-Cal patients get sicker while waiting for care, and are particularly likely to be diagnosed at late stages of breast, colon, and rectal cancer, the plaintiffs say.
Castañeda said she nearly died while waiting for gall bladder surgery after her doctor canceled her surgery twice because he refused to take Medi-Cal. Castañeda finally had emergency surgery in Mexico, a year after she was diagnosed. She developed complications due to the delay and can no longer work.
“I felt powerless and frustrated knowing I couldn't better my situation," Castañeda said at the news conference through an interpreter.
