California-based AIDS Healthcare Foundation (AHF) held a recent teleconference in which DOTmed News participated, to discuss the recent California Superior Court of California decision by judge James C. Chalfant holding that the California Department of Health Care Services (DHCS) failed to meet its statutory duties. AHF filed the case 'Weinstein, et al vs. California Department of Health Services et al' to compel DHCS to comply with legislation intended to extend Medi-Cal (the state Medicaid program) coverage to HIV-positive individuals who would otherwise qualify for Medi-Cal. The court granted AHF's petition for writ of mandate to compel compliance with the law. AHF must now submit a judgment to the judge to sign in order to make the decision final.

AHF is a healthcare provider and advocate for HIV patients. The teleconference featured AHF's President, Michael Weinstein, General Counsel Tom Myers, General Counsel, and Legal Counsel Laura Boudreau.

The legislation, under California's Welfare & Institutions Code 14149.3, was intended to address the health care disparity among those Medi-Cal eligible Californians diagnosed with AIDS, and HIV-positive individuals otherwise qualifying for Medi-Cal (on needs-based and other criteria), but who do not have clinical AIDS-and who therefore had to self-pay for care and treatment or go without.

The expansion of the existing Medi-Cal program was to be funded by the cost savings achieved through the voluntary enrollment into the existing Medi-Cal managed care program of persons who are disabled as a result of AIDS, and who are either receiving Medi-Cal benefits on a fee-for-service basis or who become eligible to receive Medi-Cal benefits. The legislation directs the DHCS to encourage the voluntary enrollment of AIDS-disabled individuals into Medi-Cal managed care through all outreach and awareness activities necessary to implement the requirement. However, the AHF representatives said that the state failed to both encourage enrollment in the plans, and to see whether the law could work from an economic perspective. The state's actions "were a self-fulfilling prophecy" of failure.

"The Department of Health Care Services did not have the right to decide which law to enforce," Weinstein said. The Department of Health Care's actions were "not only decisions contrary to law but also to the directions the Governor wanted to take."

Myers said that the state's defense was that it had actually complied with the law, by sending out flyers to people in three counties and holding meetings with some physicians. "If you look at the law, it is quite direct and quite simple...At the end of the day, whatever reasons the Department came up with it's clear it simply wasn't sufficient to meet that simple express language." Weinstein quoted from the judge's decision: "DHCS does not explain why the flyers specifically discussing AB 2197 and managed care were sent to Medi-Cal recipients in just three counties and only on one occasion. The flyer could be sent out to all recipients on a periodic basis without running into any targeting problems."

Myers further commented that it seemed DHCS felt the law was not going to help too many people, and as a busy overworked and understaffed bureaucracy, certain things would get short-shrift. "However, "as Michael said, when it comes to the law, it cannot pick and choose which laws which laws DHCS will comply with and which ones it will not. The legislature stated its intention, the Governor agreed to it, it's up to the department to do it."

Weinstein then stated that he felt DHCS is "incompetent, indifferent, not accountable. In many, many of our dealings with private health care services, if it isn't their idea they simply refuse to do it... I predict they will continue to be slow even in enforcing this writ, and it will probably be necessary to go back to court and ask the court to hold them in contempt." Prior to this decision, Weinstein says, AHF offered to settle the case if DHCS would just implement the law "but they turned a deaf ear." Myers added, "The important thing is we have a clear decision by the judge that certain very clear laws have not been complied with and that is what we are going to be focused on right now."

In a broader context, Weinstein explained, the numbers of new cases of HIV are 40% higher than previously thought in the last twelve years. In California specifically, he said, there are probably 30 thousand plus individuals who are HIV positive and do not know it, and more who are positive but in regular care. "The response to AIDS in California is bad. We applaud the governor's leadership in many of these areas but he's not getting the service from his departments that is required. There is a lot of complacency about the issue; it's been around for awhile and people are not treating it with urgency. In the long run the response to AIDS in California is going to cost the state much more money...There are other places in the country where there are much better efforts to combat AIDS, and in California, a progressive state and a bellweather in many other areas, this is extremely disappointing."

DOTmed News asked the AHF's representatives how they were originally involved in the legislation. Weinstein explained, "In our clinic, and we have 12 clinics in California, we do financial screening on these approximately 6,000 patients. So we know the financial status of every one of them and what happens to our patients. Many of these clinics are on the campuses of hospitals. And for the indigent patients who are not Medi-Cal eligible, they cannot be admitted to those hospitals and they cannot get specialty referrals in many instances. So as we're trying to organize their care, it's very heartbreaking to not be able to give them the care that they need. So we devised a method whereby people could be covered without any additional expense to the state. We sponsored a bill, got it passed, got it signed, we went to endless meetings with the Department of Health Care Services to get it implemented, and now all these years later these people have been diagnosed with HIV, progressed to AIDS and dying during the time the Department of Health Care Services has not enforced this law." As a provider to and representative of patients, Weinstein said, "We brought this suit to enforce the law we had originally sponsored."