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Complaint Alleges Discrimination Against Latinos in Medi-Cal

On Tuesday, several groups filed a complaint with HHS' Office for Civil Rights alleging that California has violated the rights of low-income residents, in particular Latinos, by paying Medi-Cal providers at "inadequate" reimbursement rates and consequently limiting access to care, KQED's "State of Health" reports (Dembosky, "State of Health," KQED, 12/15).

Medi-Cal is California's Medicaid program.

Background

According to Service Employees International Union-United Healthcare Workers West, Latinos accounted for 63.2% of Medi-Cal beneficiaries in 2014, up from 49.6% in 2001. Meanwhile, reimbursement rates for Medi-Cal providers fell by 20%, compared with Medicare rates, during the same time period.

Details of Complaint

The complaint was filed by:

  • The Civil Rights Education and Enforcement Center;
  • Feinberg, Jackson, Worthman and Wasow, a law firm;
  • The Mexican American Legal Defense and Educational Fund; and
  • The National Health Law Program (SEIU-UHW release, 12/15).

The complaint names California HHS Secretary Diana Dooley and Jennifer Kent, director of the California Department of Health Care Services, as well as their departments, as respondents.

Overall, the complaint alleges that the respondents have intentionally discriminated against Latino Medi-Cal beneficiaries (Groups' complaint, 12/15).

The groups argue that California's low reimbursement rate for Medi-Cal providers causes some to deny new patients. Such a practice "effectively denies health care access to Latinos and other Medi-Cal" beneficiaries, according to the complaint (SEIU-UHW release, 12/15).

Further, the respondents have failed to raise reimbursement rates at a level high enough to ensure the availability of Medi-Cal services comparable to Medicare and employer-based coverage, according to the complaint.

The complaint asks OCR to require the respondents to:

  • Increase the Medi-Cal fee-for-service reimbursement schedule so it is equal with Medicare rates for primary care and certain specialty services;
  • Ensure managed care organizations reimburse providers at rates equal to 100% of the Medicare fee schedule; and
  • Improve oversight and monitoring to ensure access-to-care standards are enforced among Medi-Cal providers.

The complaint argues that the implementing these recommendations would not only remedy disparate care for Latinos, but also help all Medi-Cal beneficiaries (Groups' complaint, 12/15).

Next Steps

Bill Lann Lee, former assistant attorney general for civil rights at the U.S. Department of Justice, said OCR likely will investigate the situation, which could take at least six months.

He added that DHCS has 30 days to respond to the complaint (Seipel, San Jose Mercury News, 12/15).

Comments

Thomas Saenz, president and general counsel of MALDEF, said, "Latinos on Medi-Cal have the same basic right to access health care as others in California," noting, "By lowering reimbursement rates as Latinos have increased their use of Medi-Cal, California undermines strides recently made in expanding health access, and treats Latinos as second-class patients."

Meanwhile, Abbi Coursolle, of NHELP, said, "Medi-Cal should raise its reimbursement rates so doctors will treat Medi-Cal patients and monitor and assure that access to medical care is not just an empty promise" (SEIU-UHW release, 12/15).

Reaction From State Officials

In a statement, Kent said, "We work hard to serve all Medi-Cal beneficiaries equally, and independent analyses have shown that our work is having a positive impact on the health of all Californians" (San Jose Mercury News, 12/15).

Meanwhile, state Department of Finance spokesperson H.D. Palmer said Gov. Jerry Brown (D) is working on a budget plan to submit in January 2016 to the state Legislature. Palmer noted, "We have not said we're opposed to rate increases, but if you're going to have a rate increase, show us how that results in an expansion of care" ("State of Health," KQED, 12/15).

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