Settlement Increases Access to Health Care for Hundreds of Thousands of Californians

A recent settlement of a lawsuit brought by four individuals and a non-profit organization against the Department of Health Care Services will dramatically cut the time people wait to be approved for Medi-Cal health insurance coverage. Under the settlement in the case Rivera et al. v. Lightbourne et al., Alameda County Superior Ct. No. RG14740911, applicants who appear to be eligible at the time of application will not have to wait for verification of that information but instead will receive Medi-Cal covered health care services pending verification (“Accelerated Enrollment”). For most that will mean health care coverage at virtually the time of application. Applications that do not qualify for Accelerated Enrollment must still be decided within 45 days or receive a notice that additional information is needed within 45 days.

At the time the lawsuit was filed, several hundred thousand people were stuck in a backlog waiting on their applications because the state was refusing to take available steps to decide the applications more quickly. Some of the applicants had been waiting as long as 10 months, all the while without health care for critical conditions. The son of one plaintiff who was unable to get treatment for severe heart problems while he waited died shortly before the notice of Medi-Cal approval arrived, 6 months after his application was filed. According to the coroner, his death could have been prevented if he had been able to get needed treatment during the months prior to death. Others waiting in the backlog could not afford needed prescription medications, were forced to forgo treatment for serious conditions such as cancer, and incurred thousands of dollars in medical bills, all because of their delayed applications. With this settlement California takes a giant step toward ensuring that needless suffering and loss due to not being able to afford a doctor, surgery or medicine is in the past. Legal counsel for the plaintiffs were Bay Area Legal Aid, Western Center on Law and Poverty Center, Central California Legal Services, Multiforum Advocacy Solutions, Neighborhood Legal Services of Los Angeles County, and the National Health Law Program.

Read Western Center’s press release about the settlement here.