California is home to some of the most beautiful landscapes in the world, but it’s also home to disasters that will likely increase as our climate changes. Disasters often cause immediate chaos and create significant burdens in the aftermath, including obtaining health care.
Survivors of disasters have a right to get health care when, where, and how they need it. Unfortunately, they might have to fight for it. Western Center’s health care advocates created a practice tip for accessing health care after a disaster.
Due to ongoing wildfires and future disasters, survivors may need extra assistance to access health care. Fortunately, several protections help survivors access the services, supplies, and care that they need.
Read the full tip for detailed information about special rights and remedies available to survivors seeking prescription drugs, medical supplies and equipment, physician and specialist care, eligibility and coverage, health plan enrollment changes, and more. In the meantime, here are a few important points to know when trying to access health care in the wake of disaster:
Whether survivors are insured or uninsured, rights and resources exist to help replace prescription drugs, as well as medical supplies and equipment lost or destroyed during disasters.
- Uninsured survivors can access prescription drugs and supplies via the Emergency Prescription Assistance Program, which provides free refills with a prescription at participating pharmacies. To locate a participating pharmacy, call 855-793-7470 or click here.
- Insured survivors can contact their prescribing providers, pharmacies, and/or managed care plans to request refills and replacements.
- Medi-Cal Dental: Removable dental appliances may be replaced under special expedited procedures (i.e. retainers, space maintainers, partial and full dentures, and joint appliances). Claims for these appliances, exams, and radiographs should not require prior authorization, and limitations should not apply.
- FEMA Other Needs Assistance provides grants for “necessary expenses and serious needs” caused by the disaster including medical and dental expenses not covered by primary health insurance, including if insurance denies or excludes coverage, or the survivor is uninsured. Apply for FEMA benefits at Disaster Recovery Centers, (800) 621-3362, or online. Contact the California Disaster Legal Assistance Collaborative for more information.
Survivors may need access to care and medical appointments urgently during and after a disaster. Several protections require health plans and providers to make care available.
- Emergency care: Federal law prohibits hospitals from turning away pregnant people in labor and patients facing emergency medical conditions—no matter their insurance status.
- Dialysis: Patients should first contact their regular dialysis center for help locating a replacement center.
- If contracted providers are unavailable after a disaster, Medi-Cal managed care plans must still provide adequate provider networks, including by authorizing out-of-network care if no providers are available in network.
- Medicare Advantage Plans must allow members to access out-of-network care after “a Presidential emergency declaration, a Presidential (major) disaster declaration, a declaration of emergency or disaster by a Governor, or an announcement of a public health emergency by the Secretary of Health and Human Services.”
During and after a disaster, survivors may need help applying for Medi-Cal and Covered California, or just keeping their existing coverage.
- Many disaster survivors may be newly eligible for Medi-Cal due to job loss and/or reduction in earnings. They may obtain expedited Medi-Cal.
- Starting July 1, 2021, many people can get immediate full coverage when they apply for Medi-Cal at CoveredCA.com or by phone at (800) 300-1506. After a disaster, Medi-Cal application requirements are less restrictive. You can apply for Medi-Cal at any time.
- County welfare offices must continue to provide Medi-Cal eligibility services during and after disasters “without delay.” This includes in-person assistance during regular business hours, plus telephonic and internet access for Medi-Cal applications and renewals.
- A declared state of emergency in California gives affected individuals a special enrollment period to enroll in Covered California for 60 days after the date of the declaration of state of emergency.
Note: This resource is for current and future disasters in 2021 and beyond. For the latest rules on the ongoing COVID-19 pandemic, please visit the Health Consumer Alliance’s website, which is kept current with evolving pandemic rules. If you or someone you know needs assistance accessing any of these benefits, please call the Health Consumer Alliance at 888-804-3536 for free, confidential assistance.
“This is a complete 180, from potential cuts and rationing to program expansions,” said Linda Nguy, a policy advocate with Western Center on Law and Poverty.”
The stakes have never been higher for the millions of Californians who rely on the Affordable Care Act (ACA) for access to the vital health care services they and their loved ones count on every day. As the U.S. Supreme Court weighs the future of the ACA, one point is clear: this momentous law has become part of the fabric of our entire health care system.
So many things we all count on could be upended if the ACA is overturned:
- Guaranteed coverage for people with pre-existing conditions, including almost 950,000 people who have contracted COVID-19.
- The ability of 2 million young adults under age 26 to remain on their parents’ health plans.
- The expansion of Medi-Cal to nearly 4 million low-income Californians, including single childless adults between 19-25 with incomes up to 138% of the Federal Poverty Level.
- Subsidies through Covered California to make individual health insurance more affordable.
- Enhanced Medicare payments to hospitals, doctors and other providers that help ensure seniors have access to the care they need, when they need it.
Cutting through all the partisanship, politics, and legal arguments, the ACA is really about one thing: people. Without the ACA, millions of Californians who rely on its protections will be sicker, their ability to provide for their families will be at risk, and they will face an uncertain future.
With so much at stake, we hope the Supreme Court rules to protect the health of all Californians.
“David Kane, an attorney with the Western Center on Law and Poverty, which advocated for the strict time limits, said county health officials were “trying to weasel their way out of these standards in a way that goes against the interests of the patients.”
“Lawyers who work with low-income clients continue to hear from people who have lost coverage even after the counties were notified, said David Kane, a lawyer who works for the Western Center on Law and Poverty. The state should be working harder to fix the problem, which is leaving vulnerable people without coverage in the middle of the pandemic, Kane said.
“It’s August, and they still haven’t completely fixed it,” Kane said.”
“Health insurers are arguing pent-up demand,” said Linda Nguy, a policy advocate with the Western Center on Law & Poverty. “We haven’t seen that play out – but it may be too early to know for sure.”
“A lot of these benefits are benefits provided in the private market,” said Linda Nguy, a policy advocate at the Western Center on Law & Poverty. “Having a lower standard for public programs for low income and communities of color is problematic, especially in a public health crisis.”
“No one expected good news when Gov. Gavin Newsom announced the May Revision of the California budget. As the COVID-19 pandemic obliterates plans and economies, there was no expectation that California’s budget would go unscathed. However, we never predicted the biggest blow would go to California’s older adults.“
FOR IMMEDIATE RELEASE
State must reimburse or pay Medi-Cal recipients and conduct statewide outreach to thousands of Californians who may be eligible for in-home services
LOS ANGELES — Thousands of Medi-Cal beneficiaries with significant disabilities will now be able to access affordable Medi-Cal care at home, rather than going to a nursing facility. In-home care provides greater stability and health outcomes for individuals and families, and it is cost-effective for the state; but it can be prohibitively costly to pay for out-of-pocket. As a result, married people with disabilities often have to make a draconian choice: impoverish themselves and their spouses or go to a nursing facility.
“My wife and I live primarily on a fixed income of pensions and social security; we exhausted our life savings and retirement accounts paying for my care,” said plaintiff Patrick Kelley, a 68-year-old U.S. Army veteran living with spastic quadriparesis. “My wife’s ability to work was severely limited by her caregiving responsibilities to me. We spent almost all of her limited income paying for my in-home care.”
Thanks to the successful lawsuit against the state, married people with disabilities will now learn about their right to Medi-Cal eligibility so they can stay at home with their spouse, receive care, and be reimbursed through the state’s Medi-Cal program for In-Home Supportive Services (IHSS). The court ruling makes it clear that the state must fully implement a federal law, known as the expanded spousal impoverishment protection, which should have been implemented as part of the Affordable Care Act in 2014.
“This ruling will dramatically improve the quality of life for disabled Californians and their family caregivers and will prevent many Californians from falling into poverty due to the high cost of in-home care,” said Kim Selfon, IHSS Client Advocate at Bet Tzedek. “Caregivers selflessly care for their disabled spouses with courage and compassion, often to the detriment of their own finances and health. They and thousands of others will now have the support they need to continue caring for their loved ones at home.”
The two plaintiffs’ situations illustrate the diversity of the thousands of individuals that will be impacted by the outcome of this case.
“The judge’s decision is a boost to Welfare and Institutions Code section 10500, which says agencies must secure for every person the aid to which they are entitled. As California’s population ages, in-home care will become increasingly important to the future of the state,” said attorney Cori Racela of Western Center on Law & Poverty.
Plaintiff Matthew Reed is a 63-year-old man with multiple sclerosis, Bell’s Palsy, and vascular dementia from a stroke. Due to the severity of his disabilities and medical condition, Mr. Reed is eligible for Medi-Cal home services, and should have had access to care without out-of-pocket costs under spousal impoverishment protections. Instead, he was required to pay more than $1,500 per month for care, which he cannot afford.
“If the spousal impoverishment rule had been implemented as it should have, Matthew could have been found eligible for free Medi-Cal and IHSS,” said Matthew Reed’s wife, Vicki Reed. “That means my son or I could have earned IHSS wages, sparing us incalculable stress and anxiety and giving us better options for Matthew’s home care and more financial resources. I don’t want any other families to go through what we have gone through.”
The Affordable Care Act set a deadline to expand spousal impoverishment protections to home-based care starting January 1, 2014. However, the Department of Health Care Services (DHCS) failed to issue any guidance about the rule until July 2017, after Mr. Kelley and Mr. Reed brought this lawsuit.
The ruling in Patrick Kelley & Matthew Reed v. California Department of Health Care Services, et. al., was issued by a Los Angeles Superior Court judge on January 14, 2020. It concludes that DHCS must a) notify beneficiaries who could benefit from the rule, particularly those denied or discontinued from Medi-Cal because DHCS failed to implement the rule on time; b) create a process for people to be found eligible for IHSS retroactively to the date they applied for Medi-Cal; and c) allow impacted individuals to be paid for home services they were entitled to during the delay period.
“Choosing between remaining at home without needed services, impoverishing oneself and one’s spouse, or moving into a facility separate from loved ones is no choice at all,” said Claire Ramsey, Senior Staff Attorney at Justice in Aging. “This ruling means relief for many who have struggled to stay at home and in their community and receive the services they need.”
For plaintiffs: Allison Lee: Bet Tzedek, alee[at]bettzedek.org
Courtney McKinney: Western Center on Law & Poverty, cmckinney[at]wclp.org
Bet Tzedek is committed to providing free legal services to those that need them most. Bet Tzedek attorneys and advocates help people of all communities and generations secure life’s necessities. Wherever people are in crisis, Bet Tzedek’s core services and rapid response programs provide stability and hope. Founded in 1974, Bet Tzedek – Los Angeles’ House of Justice – helps over 50,000 people each year.
Justice in Aging is a national organization that uses the power of law to fight senior poverty by securing access to affordable health care, economic security, and the courts for older adults with limited resources. Since 1972 we’ve focused our efforts primarily on fighting for people who have been marginalized and excluded from justice, such as women, people of color, LGBTQ individuals, and people with limited English proficiency.
Disability Rights California (DRC) is the agency designated under federal law to protect and advocate for the rights of Californians with disabilities. The mission of DRC is to advance the rights, dignity, equal opportunities, and choices for all people with disabilities. www.disabilityrightsca.org.
About Western Center on Law & Poverty
Western Center on Law & Poverty fights for justice and system-wide change to secure housing, health care, racial justice and a strong safety net for low-income Californians. Western Center attains real-world, policy solutions for clients through litigation, legislative and policy advocacy, and technical assistance and legal support for the state’s legal aid programs. Western Center is California’s oldest and largest legal services support center.