Rebecca Binsfield of Sacramento says she used to get treatment for lupus at UC Davis Medical Center. But then, she says, the facility stopped accepting Medi-Cal.
“Ever since then, it’s been a rollercoaster of trying to find doctors,” she says. Binsfield says she combed through a list of local doctors who accept Medi-Cal but “literally, there are no doctors on there that accept new Medi-Cal patients, so it’s been very hard.”
Binsfield is one of the plaintiffs in a lawsuit against the state, filed Wednesday by two civil rights groups, the Mexican American Legal Defense and Educational Fund (MALDEF) and the Civil Rights Education and Enforcement Center, on behalf of several patients, labor groups and a Los Angeles health clinic. The suit alleges the state is violating the civil rights of Latinos enrolled in Medi-Cal.
The suit alleges that between 2000 and 2016, provider reimbursement rates dropped 20 percent, while the number of Latinos enrolled in Medi-Cal grew three-fold, from 2.3 million to 7.2 million.
“As the program became more brown, the state invested less green,” says Thomas Saenz, president and general counsel of MALDEF. “That pattern … is unacceptable in this state and across the country.”
The state has among the lowest provider reimbursement rates in the country.
As a result, many primary care doctors and specialists have stopped taking Medi-Cal. The number of primary care physicians participating in Medi-Cal does not meet the standards set by state regulation to ensure adequate access to care, the suit says.
This limited access to care has taken a toll on patients’ health, says Jim Mangia, CEO of St. John’s Well Child and Family Center, one of the plaintiffs.
“Some of our patients wind up in the emergency room because their specialty referral is located so far away and scheduled so far out that their disease progresses to a crisis level,” he says.
Those access issues have a discriminatory effect on Latinos, who are now the majority of people on Medi-Cal, the suit alleges.
The state Department of Health Care Services says it’s required by the federal government to monitor patient access to Medi-Cal services.
In a statement, a spokeswoman says the department has an established plan to monitor patient access to care and services in fee-for-service Medi-Cal and has not identified any systemic problems. It also routinely monitors access and network adequacy in contracting Medi-Cal managed care plans, she says.
The lawsuit seeks an increase in Medi-Cal provider reimbursement rates, to ensure enrollees have health care access comparable with other insured people. It also calls on the state to provide more oversight, ensuring patients can see primary care doctors and specialists in a timely manner.
Civil rights groups filed a similar complaint with the federal government in 2015.
The state Attorney General’s office addressed the groups’ allegations of discrimination in a May 2016 response.
“You have not alleged, and we are not aware of, any evidence that Latino beneficiaries are being treated differently than other beneficiaries under the Medi-Cal program,” wrote Deputy Attorney General Gregory Brown. “Indeed, Medi-Cal rates are uniform for all providers and patients, and they do not discriminate in any way on the basis of race, color, national origin, or any other protected category.”
In June, Gov. Jerry Brown and state lawmakers struck a budget deal that uses at least $546 million in new tobacco tax funding to increase Medi-Cal provider reimbursement rates. That would represent an increase of less than 2 percent over what the state currently budgets for Medi-Cal providers.
Medi-Cal currently serves about 12.8 million people, according to the state.