Medi-Cal [Medicaid] recipients with complex medical conditions are suing the state of California for being forced into managed care, claiming the system restricts access to vital medications and specialists. California began transferring 340,000 Medi-Cal recipients to managed care in 2011, a move that saved the state millions of dollars.
Those with complex medical needs can file an exemption from participating in managed care, says Yolanda Arias, a Los Angeles Legal Aid Foundation attorney who represents the plaintiffs. Those at risk from an interruption of medical care are clearly defined as exempt, she says, “but the state is refusing to allow exemptions because they want everybody in managed care.”
Arias accuses the state of using unwritten standards to make the system harder to navigate. “When you’re dealing with them, they’re saying black is white,” she says. “It’s clear what they’re doing is illegal, but they’re doing it anyway.“ Arias says she has seen patients resorting to emergency room care when they are refused standard medications and visits to familiar specialists. The suit seeks an end to the illegal transfers and for those denied exemptions to have their cases reevaluated.