California’s protection & advocacy system

For legal assistance call 800-776-5746. For all other purposes call 916-504-5800 in Northern CA

or 213-213-8000 in Southern CA. TTY 800-719-5798.

 

Health Care

 

DRC works to ensure that people with disabilities have access to essential health care services and a full range of community long-term services and supports to enable them to live in the community and avoid institutionalization, consistent with the principles of the Supreme Court’s Olmstead decision.

This page provides information about the work that Disabilty Rights California does, as well as fact sheets and resources about the publicly-funded health benefits people with disabilities can receive.  This page concerns rights and services under public benefits programs, including Medi-Cal and Medicare. 

Medi-Cal is California’s Medicaid program.  Medi-Cal is a public health insurance program which provides needed health care services for individuals with limited income including families with children, seniors, persons with disabilities, individuals in foster care, pregnant women, low income people with specific diseases such as tuberculosis, breast cancer or HIV/AIDS, and other individuals with incomes at or below 138% of the federal poverty level.  

Medicare is the federal health insurance program for people who are 65 or older, certain people under age 65 with disabilities, and people with End-Stage Renal Disease

 

Cases

Impact/Systemic Cases

Jerry Thomas, et al., v. Jennifer Kent, Director of Department of the Health Care Services, and California Department of Health Care Services because DHCS failed to provide services so individuals can stay out of nursing homes.

David Oster et al v. Lightbourne settled in 2013; a landmark case that, starting with an injunction in 2009, kept the state from making a 20% cut in hundreds of thousands of people's In-Home Supportive Service hours.

Esther Darling et al. v. Toby Douglas, Director of California Department of Health Care Services major case settled in 2012, filed to keep state from eliminating the hundreds of community-based adult day healthcare centers relied on by 35,000 people with disabilities and seniors.

Mark Chambers v. City and County of San Francisco (LHH): Groundbreaking agreement with San Francisco to create new housing and community services for seniors and adults with disabilities

 

Individual Cases

Pablo Carranza v. Toby Douglas settled in 2012, protected Pablo, a young man with muscular dystrophy, from losing critical home nursing hours just because he had turned 21.

 

Publications

 

General Information
Medi-Cal Managed Care
Affordable Care Act (ACA) and Expansion Medi-Cal
Supports for Community Living
Nursing Facility & Hospital Discharge Rights
Access and Accommodations in Health Care

 

General Information
-- Medi-Cal: Where to Find Laws, Regulations, and Other Helpful, Free Information on the Internet (pdf) (rtf) (Pub #5511.01, April 2016)
-- Applying for Medi-Cal and Other Insurance Affordability Programs (pdf) (rtf) (June 2017, #5550.01)
--How Can I Use My Share of Cost to get More Services I Need? (pdf) (rtf) (April 2017, #5596.01)
--Worksheets for Determining Eligibility under the Aged & Disabled Federal Poverty Level (A&D FPL) Medi-Cal Program (September 2016, (pdf) #5450.01)
--For Information about Children’s health issues, including EPSDT (Early Periodic Screening, Diagnosis, and Treatment (EPSDT) Program) visit our page at : http://www.disabilityrightsca.org/pubs/PublicationsChildrensHealth.htm

--For information about In Home Supportive Services (IHSS) visit our page at http://www.disabilityrightsca.org/pubs/PublicationsIHSS.html   and http://www.disabilityrightsca.org/pubs/PublicationsIHSSNutsandBolts.htm

--For information about IHSS, Waiver Personal Care Services (WPCS) and Overtime, visit our page at http://www.disabilityrightsca.org/Events/2016IHSSOvertimeInformation.htm

Medi-Cal Managed Care

Starting in 2011, the state of California moved most seniors and persons with disabilities (SPDs) who receive Medi-Cal but not Medicare also into Medi-Cal Managed Care.  The Coordinated Care Initiative  (described below) is part of California’s move to provide most Medi-Cal in the state through managed care plans to additional SPDs who receive both Medi-Cal and Medicare. More information about Medi-Cal managed care is below.

 
--Medical Exemption Requests (MERs) (pdf) (rtf) (Pub #5595.01, January 2017)
--Medi-Cal Managed Care: An Independent Medical Review (IMR) Can Change a Plan’s No to Yes (pdf) (rtf) (January 2017, #5534.01)
--Medi-Cal Managed Care: "Continuity of Care" (pdf) (rtf) (February 2017, #5545.01)
--Medi-Cal Managed Care for Seniors and Persons with Disabilities in Some Rural Counties (pdf) (rtf) (September 2014, #5558.01)
--Medi-Cal Managed Care Health Plans: What are they? What do I need to know about them? (pdf) (rtf) (September 2016, #5495.01)
--Medi-Cal Managed Care: Not Required if You Have Private Insurance (pdf) (rtf) (September 2016, #5589.01)
--Medi-Cal Managed Care - Out-of-Network Services (pdf) (rtf) (October 2016, #5559.01)
--Timely Access to Medical Care (pdf) (rtf) (May 2016, #5556.01)
--Coordinated Care Initiative (CCI): Basics for Consumers (pdf) (rtf) (September 2016, #5535.01)

 

Affordable Care Act (ACA) and Expansion Medi-Cal

California has expanded its Medi-Cal program pursuant to the Affordable Care Act (ACA), a.k.a. “health reform” or “Obamacare.” More information about Expanded Medi-Cal is below.

--What is Adult Expansion / MAGI Medi-Cal? (pdf) (rtf) (April 2014, #5551.01)

 

Supports for Community Living

The following documents include information on community-based alternatives to nursing facility and hospital care
-- The Nursing Facility/Acute Hospital Waiver: The Basics (pdf) (rtf) (January 2017, #5591.01)
-- How the AIDS Medi-Cal Waiver Can Help You Get the Care You Need At Home (htm) (pdf) (August 2017, #5435.01)
-- How to Get the Extra Help You Need to Stay in Your Own Home and Avoid a Nursing Home (html) (pdf) (August 2017 #5392.01)
-- The Multipurpose Senior Services Program May Be the Answer to Staying at Home Rather than Going to a Nursing Home (htm) (pdf) (November 2008, #5395.01)

-- For information about In Home Supportive Services, Medi-Cal funded attendant care for people living in the community, see http://www.disabilityrightsca.org/pubs/PublicationsIHSS.html and http://www.disabilityrightsca.org/pubs/PublicationsIHSSNutsandBolts.htm

 

Nursing Facility & Hospital Discharge Rights

The following documents include information on discharge planning for individuals who are in nursing facilities and want to return home, and advocacy tools for residents of nursing facilities and individuals who have been hospitalized and want adequate discharge planning.  
--Enhanced Discharge Planning Rights For Nursing Facility Residents Under MDS 3.0 Section Q (pdf) (rtf) (March 2011, #5496.01)
--Your Rights to Choices Counseling and Discharge Planning Under MDS 3.0 Section Q (pdf) (rtf) (March 2011, #5497.01)
--Using Your Medi-Cal Share of Cost if You are a Nursing Facility Resident (pdf) (rtf) (April 2017, #5597.01)

 

Access and Accommodations in Health Care

The following publications provide information about how to access and use aids and services when getting health care. 
--Access to Health Care for People with Disabilities under the ADA and other Civil Rights Laws (pdf) (rtf) November 2013. #5531.01
--How to Use Aids and Services in Medical Settings (htm) (pdf) (March 2005,#5447.01)
--Access to and Amendment of Health Records (htm) (pdf) (December 2007, #5112.01)


Media

 

Legislation

 

AB 286 (Gipson) – Medi-Cal: Home Upkeep Allowance

In the last legislative session, DRC sponsored AB 1235 (Gipson) that would have increased the Home Upkeep Allowance to allow Medi-Cal recipients in nursing homes to retain funds to use to return to their home or to obtain a home for their return. That bill was held in the Senate Appropriations Committee last year after only receiving one “no” vote in the Assembly and the Senate Health Committee. Assembly Member Gipson has reintroduced this legislation again as AB 286.

This bill has been amended from last year’s bill to tie the allowance to 100% of the federal poverty level, which would raise the amount from $209 per month to $990. This is a lower amount than previously proposed in AB 1235 after receiving some informal technical assistance from the California Department of Health Care Services last year indicating that the lower amount may be feasible. Inasmuch as the Home Upkeep Allowance has remained unchanged since the 1970s, this increase could provide a significant opportunity for nursing home residents who can return to their homes.

http://www.disabilityrightsca.org/legislature/Legislation/2017/Letters/AB286GipsonHomeUpkeepAllowanceSponsorandSupportFinalMarch272017.pdf

 

Legistlation 2017-2018 Budget includes a provision sposored by DRC and IHSS Coalition to codify existing administrative exemptions to the workweek limits for inhome care providers.
http://www.disabilityrightsca.org/legislature/budget/2017/BudgetSummary2017June16.pdf

 

Helpful Links

 

Helpful Links about Medi-Cal

--Health Consumer Alliance’s Overview of the Medi-Cal Program: http://healthconsumer.org/publications.htm#manuals

--Worksheets for Determining Eligibility under the Aged & Disabled Federal Poverty Level (A&D FPL) Medi-Cal Program (2009-2010, (pdf) (rtf) (html), #5450.01) (Plain English (pdf) #5450.PE)

--National Health Law Program: http://www.healthlaw.org/issues/medicaid

--Justice in Aging www.justiceinaging.org

 

Helpful Links about Medi-Cal managed care

--The Department of Health Care Services, which administers Medi-Cal:
http://www.dhcs.ca.gov/services/Pages/Medi-CalManagedCare.aspx

--For information about Medi-Cal managed care plans you can visit:
http://www.healthcareoptions.dhcs.ca.gov/HCOCSP/Home/default.aspx

--See also, Department of Managed Health Care: http://www.dmhc.ca.gov/

--For detailed information and updates about the CCI see: http://www.calduals.org

--Justice in Aging has CCI information including publications and webinars, see:http://www.justiceinaging.org

--Information from the Department of Health Care Services, which administers the CCI is available at: http://www.dhcs.ca.gov/dataandstats/statistics/Pages/Medi-CalCCI.aspx

--The California Department of Aging has information about the CCI at: http://www.aging.ca.gov/Resources/CalMediConnect/

--The Health Insurance Counseling and Advocacy Program (HICAP) has a CCI publication, Frequently Asked Questions, available at:  http://www.aging.ca.gov/Resources/Docs/HICAP%20CCI%20FAQs%20Jan%2024.pdf

--For problems with CalMediConnect you can contact:http://www.calduals.org/implementation/policy-topics/ombudsman-resources/

--For problems with Medi-Cal managed care you can contact the Medi-Cal Managed Care ombudsman program at: http://www.dhcs.ca.gov/services/medi-cal/Pages/MMCDOfficeoftheOmbudsman.aspx

 

Helpful Links about ACA

--Justice in Aging (www.justiceinaging.org) has information about the ACA, including a publication entitled “Medicaid Expansion in California:  Opportunities and Challenges for Older Adults and People with Disabilities” available at http://www.justiceinaging.org/wp-content/uploads/2013/11/1CA-Eligibility-Brief-4.pdf

--The National Health Law Program (NHeLP) has a variety of publications about the ACA at http://www.healthlaw.org/issues/california/health-reform

--See also, “Advocate's Guide to MAGI” (Modified Adjusted Gross Income, used to determine Expansion Medi-Cal eligibility): http://www.healthlaw.org/publications/agmagi#.UvpmRkKwKk0

--The Western Center on Law and Poverty has a variety of publications available at http://www.wclp.org/Resources/Health/tabid/1398/Default.aspx

--Information about Covered California, the marketplace providing ACA coverage (other than Medi-Cal) in California is available at https://www.coveredca.com/

 

Helpful Links about Supports for Community Living

--Home and Community Based Waiver Services (HCBS).  HCBS waivers provide in-home care in the community to people who would otherwise be in nursing facility level or higher level of care facilities.  The services available under the HCBS waivers administered by the California Department of Health Care Services (DHCS) include case management, community transition services, private duty nursing, family training, home health aides, life-sustaining utility reimbursement, habilitation services, and respite care.  Information about Medi-Cal-funded HCBS waivers is available at  http://www.dhcs.ca.gov/services/Pages/HCBSWaiver.aspx And http://www.dhcs.ca.gov/services/ltc/Pages/AssistedLivingWaiver.aspx

 

Helpful Links about nursing homes, discharge and transfer rights and other personal rights

--California Advocates for Nursing Home Reform has a wealth of information about rights in Nursing Facilities, Residential Care Facilities, and Hospitals: http://www.canhr.org/factsheets/index.html

--The National Senior Citizen’s Law Center (http://www.JusticeinAging.org) has a  booklet for advocates, family members, and consumers entitled 20 Common Nursing Home Problems –and How to Resolve Them  available at:  
http://www.JusticeinAging.org/index.php/store/books/

 

Other Useful Information

--Advance Health Care Directives (pdf) March 2003, #5088.01

--References for Consumer Complaints About Health Care Professionals & Facilities (pdf) (October 2010, #5287.01)

-- Access to and Amendment of Health Records (html) (pdf) (Pub #5112.01).  http://www.disabilityrightsca.org/pubs/PublicationsMentalHealth.htm.

--Information about Health Insurance Privacy Rights under the the Health Insurance Portability and Accountability Act of 1996 (HIPAA)
is available at http://www.hhs.gov/ocr/privacy/index.html  and http://www.hhs.gov/ocr/privacy/hipaa/complaints/index.html

--The Department of Justice has information about what is effective communication at: http://www.ada.gov/effective-comm.htm and information about mobility devices in public accommodations at: http://www.ada.gov/opdmd.htm