Dive Brief:
- A lawsuit filed by a handful of California organizations including Bay Area Legal Aid, is claiming the state is failing its legal obligation to process state Medicaid applications within 45 days of receipt.
- The suit is charging that some applicants to the Medi-Cal program have been waiting for a response since the end of 2013. These patients are low-income, sometimes with life-threatening conditions with the least access to the healthcare system. The suit cites several cases where people were unable to receive care or had to seek legal assistance before receiving an answer to their application.
- There are approximately 11 million Medi-Cal beneficiaries in the state, 2.2 million of whom have applied this year. There are about 350,000 pending applications. California's Department of Healthcare Services has said the backlog has been reduced and many cases are pending because of incomplete or incorrect information provided by the applicants. People who receive care while applications are pending can get their bills covered by the program, according to a spokesperson from the department.
Dive Insight:
In the lawsuit, plaintiffs are requesting the state begin granting benefits to people within its 45-day period even if they are still verifying peoples' incomes. They are also asking the state to send information to patients so they will be aware of their right to get legal assistance if their application is delayed.
The application process isn't the only concern in the state. A recent report by the The California Healthcare Foundation questioned whether or not there will be a sufficient amount of providers to care for the 2 million extra people expected to enroll in 2015. The report said the number of beneficiaries will likely top 11.5 million next year.
The federal government recommends there be 70 full-time physicians per 100,000 Medi-Cal enrollees. California has only 42 for every 100,000 and fewer than 70% of the state's physicians accept the payer (only 54% of which are solo practices).