Court Puts an End to Medi-Cal Limbo and Orders State to Issue Timely Healthcare Benefits

Low-income Medi-Cal applicants - including children, pregnant women, and people with life-threatening illnesses - will no longer have to wait for months while their health deteriorates.  A recent court decision from Alameda County Superior Court ruled that 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.


Frances Rivera, a plaintiff in the case, from Visalia, had her son, Robert Cribbs, die while waiting for a decision on his Medi-Cal application.  The January 20 ruling gives hope to Rivera that 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."

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 eligiblity decisions.  Others must be notified within 45 days that they have a right to an administrative hearing to get a decision on eligibility.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 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 Central California Legal Services, Bay Area Legal Aid, Multiforum Advocacy Solutions, National Health Law Program, Neighborhood Legal Services of Los Angeles County, and Western Center on Law & Poverty.

"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."

Thousands of eligible applicants are still in the backlog and are entitled to relief under the Court's order.  Medi-Cal applicants who have been waiting more than 45 days for a Medi-Cal eligibility determination should contact Central California Legal Services at 1-800-675-8001.