Low-income applicants—including children, pregnant women, and people with life-threatening illnesses—will no longer have to wait for months while their health deteriorates

January 2015 - OAKLAND, CA – If the state is unable to determine whether an applicant is eligible for Medi-Cal within 45 days, it must grant that applicant temporary health benefits, ruled the Alameda County Superior Court. The January 20 ruling (attached) marks a major victory for low-income Californians, many of whom had been stuck in a kind of Medi-Cal limbo while their health deteriorated.

Frances Rivera, a plaintiff in the case whose son died while waiting a decision on his Medi-Cal application, said she is relieved to hear other families will be spared the same misfortune.

“I am just thrilled that the people who need Medi-Cal will be able to get it in a timely manner,” she said. “Hopefully somebody’s life will be saved because of this decision.”

Two months after her son died of a pulmonary embolism—and seven months after he submitted his application—Rivera received a letter stating he qualified for Medi-Cal, and that his coverage would apply retroactively.

The ruling orders the State Department of Health Care Services to grant provisional benefits to applicants who are likely eligible and whose applications have not been decided within 45 days—the legal time limit for making most Medi-Cal eligibility decisions. Others must still be notified within 45 days that they have a right to an administrative hearing to get a decision on eligibility. 

“After the lawsuit was filed and right before a court hearing, the state managed to bring down the backlog numbers, showing that a remedy was well within the state’s control all along,” said Michael Keys of Bay Area Legal Aid. “The ruling protects hundreds of thousands of new Medi-Cal applicants from the specter of a new backlog building back up to the 900,000 heights we saw last spring.”

The lawsuit, filed September 17, accused the State of California of leaving hundreds of thousands of low-income applicants to wait for months without the healthcare they desperately needed and lawfully deserved. It was brought by a coalition of legal services organizations and community healthcare advocates, including Bay Area Legal Aid, Central California Legal Services, Multiforum Advocacy Solutions, National Health Law Program, Neighborhood Legal Services of Los Angeles County, and Western Center on Law & Poverty.

Thousands of eligible applicants are still in the backlog and are entitled to relief under the Court’s order. Medi-Call applicants who have been waiting more than 45 days for a Medi-Cal eligibility determination should contact the Health Consumer Alliance for assistance at 1-888-804-3536.