LOS ANGELES (CN) — Thousands of sick and disabled Los Angeles County residents are wrongly denied health care through California Medicaid because the county fails to process their renewals on time, advocates for the poor claim in court.
St. John’s Well Child and Family Center claims in Superior Court that L.A. County, its Department of Public Social Services and Director Sheryl L. Spiller have a backlog of thousands of timely renewals waiting to be processed.
Under state law, the department should renew eligible recipients’ Medi-Cal coverage annually. So long as the recipients turn in their renewal forms, the process should be foolproof and nearly automatic, the Family Center says in the Dec. 21 complaint.
Instead, the county department “knowingly and unlawfully terminates Medi-Cal benefits for thousands of people … by failing to timely process annual Medi-Cal renewal forms in accordance with the law,” the lawsuit states.
Once renewal is denied, people often cannot get the medical treatment or prescription medicines they urgently need, St. John’s and three individual plaintiffs say.
They say the county had a backlog of 12,700 terminated cases in October, though all the beneficiaries had turned in their information on time.
The Department of Social Services department did not return a phone call seeking comment Thursday.
Roughly 100,000 to 150,000s renewals come due every month, according to lead attorney David Kane, with Neighborhood Legal Services of Los Angeles County. But because of a rush of signups under the Affordable Care Act a year ago, more than 200,000 renewals come due at the end of this month.
If the department can’t process those on time, people will lose healthcare services the next day. “If anybody goes to the doctor on Jan. 1 or 2, they might find their Medi-Cal is cut off,” Kane said.
He asks the court to order the county to stop terminating anybody’s Medi-Cal coverage until the problems are solved.
Kane is assisted by attorneys with Kirkland & Ellis and the Western Center on Law and Poverty.
Medi-Cal recipients “are among California’s poorest residents,” according to the 23-page complaint. A single adult with no dependents must earn less than $1,367 per month to qualify.
Lead plaintiff Thaddeus Moncrief is paraplegic and sent in his renewal paperwork on time, but the county did not process it. As a result, he went three months without coverage and could not obtain the catheters, colostomy pouches and medicine he needed, nor could he pay for repairs to his wheelchair, according to the complaint.
“I was basically confined to the house,” he said in a statement. “For me, nothing like this is ever supposed to happen.”
Plaintiff Hilda Rodriguez has end-stage renal disease and was removed from the list for a kidney transplant and had to fight to continue dialysis treatments when her Medi-Cal coverage terminated.
Plaintiff Carol Northern needs several medications to treat a hole in her heart and related conditions.
“Ms. Northern twice timely submitted her annual redetermination paperwork, first in February and then again in April 2016,” the complaint states. But the department claimed it hadn’t received the forms and terminated her Medi-Cal coverage on May 31.
When she found out about that in August, she contacted the county. Eventually, a supervisor acknowledged the department had received the paperwork in April but had never processed it, the complaint states.
After she was terminated, Medi-Cal stopped paying for her Medicare coverage, so “hundreds of dollars were deducted from her Social Security income from July through August of 2016, and she could not pay her rent on time.”
St. John’s Well Child and Family Center is a chain of 13 nonprofit health clinics that offer free or low-cost services to more than 85,000 patients a year. It says thousands of its patients have lost Medi-Cal coverage because of the county’s failures.
“As a result, St. John's has lost millions of dollars in funding for uncompensated patient visits, forcing them to ration their offered health care,” it says.
Kane said his office has discussed the renewal backlog problem several times with county officials.
“They admitted it was a problem and told us it had been fixed,” he said. “Then we just kept seeing it again,” as more people came to Neighborhood Legal Services seeking help.
They seek writ of mandate, a restraining order and injunction against the defendants’ violations of the Welfare and Institutions Code, disability discrimination, Medi-Cal violations, due process violations and misuse of public funds, plus costs of suit.
Read the Top 8
Sign up for the Top 8, a roundup of the day's top stories delivered directly to your inbox Monday through Friday.