May 17 2018
Los Angeles County unlawfully dropped an estimated 22,000 people from California's Medicaid program, including low-income seniors and disabled residents who couldn't get vital medications and medical care after their coverage was terminated, according to a court ruling late last week.
The May 10 decision, by Superior Court Judge James C. Chalfant, ordered the county's Department of Public Social Services to fix the problem that resulted in so many people getting cut off — though he did not specify how that should be done.
The department dropped people between December 2016 and December 2017 before processing their renewal applications, even though they had filed on time, according to plaintiffs' arguments in court papers.
Chalfant also said the county had failed to reinstate beneficiaries who had submitted missing information within a 90-day grace period.
He did not explicitly order the county to reinstate enrollees who were wrongfully dropped from the public health insurance program for people with low incomes, known as Medi-Cal in California.
The renewal applications hit a snag as Medicaid rolls in California swelled following the expansion of the program under the Affordable Care Act. The health law took effect in 2014, and an estimated 3.8 million people newly eligible for Medi-Cal have signed up since then.
One of the plaintiffs was 50-year-old Thaddeus Moncrief of Lancaster, Calif., who is paraplegic. He said Friday that he couldn't get his blood pressure medications, catheters or colostomy bags after his Medi-Cal benefits suddenly stopped in 2016. Moncrief said he also was unable to get badly needed repairs made to his wheelchair.
He said he had sent in his renewal documents on time. "When I tried to contact Medi-Cal, they gave me the runaround," he said. "I was pretty upset. I had been on disability and Medi-Cal for about 20 years. There was never a problem before."
After seeking legal help, Moncrief's benefits were reinstated. He said he hoped the ruling "will make a difference for a lot of people."
Attorneys for the plaintiffs lauded the ruling as a "remarkable protection of patient rights" for L.A. County residents on Medi-Cal.
"Medi-Cal is a lifeline to millions of people in our county," said David Kane, staff attorney at Neighborhood Legal Services of Los Angeles County, one of the organizations that filed the suit. "When you yank that away from somebody, it jeopardizes their very livelihood."
Officials at the L.A. County social services department declined to be interviewed but said in a written statement: "It's important to note that we are strongly committed to serving the public and making improvements in our processes wherever we can."
Attorneys for the county said in court documents that the thousands of dropped cases represented "a fraction of one percent" of the total renewal packets processed during that time. Though it is "unfortunate" when anyone eligible for benefits is denied, there is no systemic problem, the county's lawyers argued. The county processes about 120,000 Medi-Cal renewals every month.
The judge did not agree with the plaintiffs' assertion that the county had systemically failed to send notices and renewal packets to beneficiaries early enough.
The case against L.A. County was originally filed in 2016 on behalf of three beneficiaries and St. John's Well Child and Family Center, which serves large numbers of Medi-Cal patients. The attorneys who filed the suit asked the judge to order that the county follow the law when processing Medi-Cal applications.
The Medi-Cal program covers more than 13 million Californians, roughly a third of the state's population. Most Medi-Cal beneficiaries must submit financial and other information annually to have their enrollment renewed.
Carol Northern, a plaintiff who lives in Palmdale, Calif., called the decision a "win in favor of the people out there who can't fight for themselves."
Northern, 67, said the county terminated her Medi-Cal benefits in 2016 and she feared she wouldn't be able to continue getting care for her heart and lung conditions. Northern, who depends on supplemental oxygen and medications, said she was devastated. "I didn't know how I was going to pay for medical bills if I was not covered," she said. Her benefits have since been restored.
Jim Mangia, CEO of St. John's Well Child and Family Center, said many of his patients waited many months for their Medi-Cal benefits to be reinstated. During that time, the health center provided millions of dollars in medical services without reimbursement but was unable to refer many patients for diagnostic tests or to see outside specialists, Mangia said.
"Thousands of patients were getting sicker," he said. "They did not receive the care that they not only needed but also deserved."
This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.