A Visalia mother who says her son died while waiting to be qualified for Medi-Cal is suing the state to end a backlog of 350,000 unprocessed Medi-Cal applications.
Frances Rivera is one of five petititoners asking that the state be ordered to enroll applicants within 45 days, as is required by law, said Gillian Sonnad, a lawyer for Central California Legal Services in Fresno.
Hundreds of thousands of people have been stuck -- some for months -- waiting to receive Medi-Cal cards and "unfortunately, this has some really tragic consequences," Sonnad said.
At a minimum, the state should send a notice to applicants that they have the right to go to a hearing and have their eligibility determined, she said.
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Anthony Cava, a spokesman for the state Department of Health Care Services, explained the agency is unable to comment on pending or ongoing litigation, but he said: "As of mid-August, the latest information available, there were 350,000 individuals pending who had applied more than 45 days prior to that time. Since then, many of those applications have been processed, and we are currently updating our numbers to reflect that activity."
The state did not have specific numbers for counties. But Tulare County Health and Human Services had a backlog of roughly 2,100 through Aug. 31, said spokeswoman Tammie Weyker.
The lawsuit is not a class-action suit, but its outcome would affect the state's Medi-Cal population, said Jen Flory, a lawyer for the Western Center on Law and Poverty in Sacramento. The lawsuit was filed Wednesday in Alameda County Superior Court, she said. The suit was brought by a coalition of legal services organizations and community health care advocates that includes Central California Legal Services and the Western Center on Law and Poverty.
According to the plaintiffs, applicants who are waiting to receive Medi-Cal cards include children, pregnant women, people with disabilities and those with life-threatening illnesses.
Rivera was not available for comment Wednesday evening, Sonnad said.
But her son, Robert Cribbs, 48, of Visalia, died of a pulmonary embolism while waiting for his Medi-Cal card, according to a written statement from the legal services organizations.
Cribbs had suffered from an array of conditions over the years, and his mother knew something was wrong with his heart, the organizations said. He worked a low-wage job and could not pay for insurance, and Rivera would take him to the emergency room when he was in pain.
The family was encouraged when he applied for a subsidized plan under Covered California, the state's health insurance exchange, the organizations said. But he was told he might qualify for Medi-Cal and that his application would be forwarded to his county's Medi-Cal office. He was advised to wait to hear back on his status, they said.
He was still waiting five months later when he died, they said. Two months after he died, Rivera received a letter stating Cribbs qualified for Medi-Cal and his coverage would apply retroactively, they said.
Flory said the plaintiffs -- Rivera and two individuals from Los Angeles County, another from Alameda County and a health provider from Los Angeles -- will ask for the first hearing date available.
The lawsuit was brought after meetings with the Health Care Services department failed to resolve the backlog, Flory said. "We feel like we've just come to the end of the line" in talking with the state, she said.
The organizations and state had been meeting on almost a weekly basis, she said, and the groups had sent letters of recommendations to eliminate the backlog, including giving presumptive eligibility to all the applicants and using an accelerated enrollment process for children. "There are other ways to clear the backlog that they have chosen not to," she said.
Cava said there are reasons for some applications to be pending, such as a missing pay stub to verify income or omitted information.
The department and its county partners also have to deal with duplicate applications that occur when a person starts more than one application, he said.
Flory said the petition for a writ of mandate doesn't tell the state how to eliminate the backlog. "We're just asking them to follow the law."