A court decision this week could help thousands of central San Joaquin Valley consumers who have been waiting months for Medi-Cal cards.
An Alameda County Superior Court judge has ordered California to determine Medi-Cal eligibility within 45 days — the legal time limit for making most Medi-Cal eligibility decisions — if the applicants appear to be eligible. And others whose eligibility is less clear must be notified of the right to a hearing.
The decision also says the state likely may not be able to comply, and so at its discretion, may provide provisional benefits to those who are eligible but whose applications have not been processed within 45 days.
Thousands of Californians have been stuck in a kind of Medi-Cal limbo while their health deteriorated, according to attorneys for plaintiffs who sued the state. The state-federal insurance program provides mostly free care to low-income families and individuals.
One of the plaintiffs in the case, Frances Rivera, 68, of Visalia, has said her son, Robert Cribbs, waited five months for a Medi-Cal card that did not arrive until two months after his death of a pulmonary embolism in April 2014.
Thursday, Rivera said in a written statement: “I am just thrilled that the people who need Medi-Cal will be able to get it in a timely manner. Hopefully somebody’s life will be saved because of this decision.”
County welfare workers were overwhelmed by Medi-Cal applications that coincided with the first open enrollment for the Affordable Care Act from October 2013 to April 1, 2014. More than 1 million enrolled in Affordable Care Act health plans offered through Covered California, the state’s health insurance exchange. But even more — 2.7 million — enrolled in Medi-Cal, and at one point, the Medi-Cal application backlog reached 900,000 statewide.
Anthony Cava, a spokesman for the California Department of Health Care Services, said the department already has undertaken actions. Since Jan. 1, the department has given coverage to people prior to their cases reaching the 45-day limit, he said. And the state has “virtually cleared the number of pending individuals, reducing it by more than 95%.”
The state is processing the remaining pending applications this week, Cava said. But multiple factors affect processing, he said. For example, many people have yet to provide information needed to verify their eligibility, and many other applications are duplicates that have to be be removed from the system.
In the court ruling issued Jan. 20 by Alameda County Judge Evelio M. Grillo, the state’s latest estimate was that the backlog had been reduced to approximately 44,143. And in his ruling, Grillo said the reduction demonstrated the state “is capable of significantly reducing the backlog” and that the department had not “established that there is an administrative or other emergency that continues to be ‘beyond the Department’s control.’”
Donna Ortiz, deputy director of TulareWORKs, which signs residents up for Medi-Cal, said Tulare County. had a backlog of about 11,600 applications, but has worked to reduce that number. “Today we have about 275 applications that have been pending 45 days,” she said.
She encouraged Tulare County residents people who have applied for Medi-Cal and need immediate coverage to contact her office at (800) 540-6880. Anyone who has waited 45 days or longer for a Medi-Cal eligbility confirmation should also contact the office, she said.
Fresno County has processed nearly 58,000 Medi-Cal applications and about 2,800 remain to be processed that are older than 45 days. Some of the pending applications were held up by the state, said Linda Duchene, a Fresno County program manager. County workers are processing the claims to give the clients interim coverage, she said.
The county has been told that the state will be processing batches of applications that are nearing 45 days to give consumers temporary approval until their Medi-Cal eligibility can be confirmed, Duchene said.
A new wave of Medi-Cal applications began hitting county offices Nov. 15, the start of the second year of open enrollment for Covered California. It’s expected that Medi-Cal applications will continue to be received at a fast clip until the open enrollment ends Feb. 15.
Gillian Sonnad, an attorney for Central California Legal Services in Fresno, said the hope is that Tuesday’s court decision “means there won’t be a backlog from this most recent open enrollment period.”