California draws praise for leading the country in many ways, but our state is faltering badly in an area that is vital to millions: healthcare for our most vulnerable residents.
Fully one-third of our population, including seniors, people with disabilities and children, depend on Medi-Cal, the Medicaid health insurance program for low-income Californians. While there is wide coverage, Medi-Cal recipients have worse access to healthcare than Medicaid recipients in almost every other state, judged by the percentage of physicians who accept Medicaid patients.
This means suffering for people who have health coverage but, in fact, can’t get care. Too often, Medi-Cal patients are told no doctors will treat them, must endure long delays in scheduling appointments, and are forced to travel long distances for care. Poor, disproportionately Latino Medi-Cal patients often are unable to access care they would receive if covered by other health insurance.
While California has wide coverage, so few doctors here accept Medi-Cal patients that recipients have worse access to healthcare than Medicaid recipients in almost every other state.
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Our state’s payments are so low that they deter many providers from treating more than a few, if any, Medi-Cal patients, with physicians saying that Medi-Cal payments are far below their costs of providing care, whether in fee-for-service or managed care.
This not only endangers the health of millions of Californians, but as our state officials should know, it violates health and civil rights laws.
Today, Latinos are more than half of all Medi-Cal enrollees statewide. As Latino enrollment in the program surged, Medi-Cal’s relative reimbursement rates plummeted.
In 2000, Medi-Cal rates were about two-thirds of Medicare’s, but they have fallen to about half what Medicare pays. Meanwhile, the number of Latinos in Medi-Cal climbed from 2.3 million in 2000 to 7.2 million in 2016. California’s politicians cannot blame financial shortfall; this alarming trend of disinvestment continued whether the state budget was tight or flush.
Civil rights and healthcare laws require that Medi-Cal recipients have access to healthcare equal to people with other insurance, such as Medicare and employer-sponsored insurance. Our state health officials have been so resistant to improving this situation that my organization, the Civil Rights Education and Enforcement Center, joined the Mexican American Legal Defense and Educational Fund to challenge this inequality.
We represent patients, a community health clinic, and a healthcare workers union demanding timely access to care for the 13.5 million Californians with Medi-Cal. They assert California is violating the civil rights of all Medi-Cal recipients because Medi-Cal is a majority Latino program with inferior access.
One of the people we represent – Saul Jimenez Perea, a 33-year-old with cerebral palsy – was unable to see a neurologist for more than a year while he was experiencing grand mal seizures. His condition also leaves him at high risk for glaucoma and blindness. Unfortunately, he could not get an appointment with an ophthalmologist for a year and has resorted to receiving care in Mexico.
Although California was one of the first states to expand eligibility for Medicaid under the Affordable Care Act, Medi-Cal’s access lags far behind the benchmark access for people covered by Medicare or their employers. Our state is near the bottom of the heap, rated 48 out of 50.
Today, when Medicaid programs are under attack from those hostile to providing health care for the poor, California should be a leader in providing access to health care. Instead, Medi-Cal is an outlier among state health programs.
Making sure that Medi-Cal provides the access to health care for those it covers is simple justice.
Bill Lann Lee, former Assistant Attorney General for Civil Rights with the U.S. Department of Justice, is Senior Counsel at the Civil Rights Education and Enforcement Center.