Medi-Cal violates civil rights

California talks big on health, but so few docs take Medi-Cal that it violates civil rights

By Bill Lann Lee
The Sacramento Bee, August 9, 2017

California draws praise for leading the country in many ways, but our state is faltering badly in an area that is vital to millions: healthcare for our most vulnerable residents.

Fully one-third of our population, including seniors, people with disabilities and children, depend on Medi-Cal, the Medicaid health insurance program for low-income Californians. While there is wide coverage, Medi-Cal recipients have worse access to healthcare than Medicaid recipients in almost every other state, judged by the percentage of physicians who accept Medicaid patients.

This means suffering for people who have health coverage but, in fact, can’t get care. Too often, Medi-Cal patients are told no doctors will treat them, must endure long delays in scheduling appointments, and are forced to travel long distances for care. Poor, disproportionately Latino Medi-Cal patients often are unable to access care they would receive if covered by other health insurance.

Our state’s payments are so low that they deter many providers from treating more than a few, if any, Medi-Cal patients, with physicians saying that Medi-Cal payments are far below their costs of providing care, whether in fee-for-service or managed care.

This not only endangers the health of millions of Californians, but as our state officials should know, it violates health and civil rights laws.


Today, Latinos are more than half of all Medi-Cal enrollees statewide. As Latino enrollment in the program surged, Medi-Cal’s relative reimbursement rates plummeted.

In 2000, Medi-Cal rates were about two-thirds of Medicare’s, but they have fallen to about half what Medicare pays. Meanwhile, the number of Latinos in Medi-Cal climbed from 2.3 million in 2000 to 7.2 million in 2016. California’s politicians cannot blame financial shortfall; this alarming trend of disinvestment continued whether the state budget was tight or flush.

Civil rights and healthcare laws require that Medi-Cal recipients have access to healthcare equal to people with other insurance, such as Medicare and employer-sponsored insurance. Our state health officials have been so resistant to improving this situation that my organization, the Civil Rights Education and Enforcement Center, joined the Mexican American Legal Defense and Educational Fund to challenge this inequality.

Making sure that Medi-Cal provides the access to health care for those it covers is simple justice.

Bill Lann Lee, former Assistant Attorney General for Civil Rights with the U.S. Department of Justice, is senior counsel at the Civil Rights Education and Enforcement Center.

Los Angeles Times editorial: Does state funding for Medi-Cal discriminate against the Latinos it serves?



By Don McCanne, M.D.

Many proclaim that the greatest success of the Affordable Care Act was the 30 percent increase in Medicaid enrollment - now 74 million individuals. But Medicaid is a chronically underfunded welfare program, critically so in states like California.

One-third of Californians are enrolled in Medi-Cal (California’s Medicaid), and over half - 7.2 million - are Latinos. Access is impaired because of a lack of willing providers due to payments that are well below the costs of providing health care. Unequal access to care violates the civil rights of the Latinos enrolled in this program. More broadly, it establishes the principle that lower income individuals on Medicaid are not entitled to the same level of access to care as those with higher incomes covered by more traditional health insurance.

A single payer system would be much more egalitarian, ensuring as much as possible that care would be there for anyone who needs it.

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