State sued over Medi-Cal patients’ switch to managed care


Legal aid organizations filed a lawsuit Friday against the California Department of Health Care Services, alleging that the state violated patients’ rights by forcing them into managed care.

The suit is on behalf of five Medi-Cal recipients, all of whom have complex medical problems. Lawyers said the patients lost access to their doctors when they were automatically defaulted into managed care.

“People can’t get the care that they need,” said Elena Ackel, an attorney with the Legal Aid Foundation of Los Angeles. “Their lives are on the line.”


In June 2011, the state began moving more than 330,000 senior citizens and disabled people into Medi-Cal managed care. The goal was to improve care and reduce costs by preventing unnecessary procedures and hospitalizations.

Department of Health Care Services officials said they could not comment because they have not been served with the suit. But they have said in the past that managed care helps oversee patients’ treatment and guides them through the healthcare system.

In a statement issued Friday, department spokesman Norman Williams said the agency “remains strongly committed to ensuring that Medi-Cal members receive the health services they need without interruption as they transition to the coordinated, efficient system of care.”

Many of the patients moved into managed care have serious illnesses, including rheumatoid arthritis, lupus and metastatic cancer. Patients could apply for temporary exemptions if they wanted to stay on a fee-for-service plan, in which the state pays doctors based on the specific treatment provided instead of a managed care general rate that is usually less.

But lawyers said patients who should have received exemptions were denied. They said the state was using a much more stringent standard than allowed by law when deciding who could stay on fee-for-service plans.

Juan Cameros, 35, is one of those patients. He has a rare disease that causes painful inflammation in his joints and has required a double hip replacement. Cameros said he was automatically placed into managed care. He couldn’t see his specialist, a surgery was delayed, and he couldn’t get access to all of his medication, according to the lawsuit.

Eventually, Cameros was given a temporary exemption. But others haven’t been so fortunate, lawyers and advocates said.

The state has failed to recognize the severity of some of the patients’ medical conditions, said Robert Newman, senior counsel at the Western Center on Law and Poverty. “A person who is receiving treatment for cancer or kidney failure cannot suddenly be cut off from their regular treating physicians and told to find new doctors to treat them,” he said in a statement.