Rivera v. Kent

Issue: Does California have a mandatory duty to perform Medicaid eligibility determinations for all applications within 45 days of completion? 

Background: Medicaid applicants sued California, in response to delays in eligibility determinations, sometimes with severe consequences for people who were unable to obtain needed healthcare. The trial court ordered California to make eligibility determinations within 45 days according to a federal regulation. The court of appeal reversed, noting that exceptions to the federal regulation make the obligation insufficiently clear to be enforced as a mandate. The California Supreme Court granted review but then held that no controversy remained, given the state’s acknowledgement that performance and timeliness standards are separate requirements.

Current Status: Final decision issued

California Supreme Court Amicus Brief, June 4, 2020 

Amici: 11 public health chairs and scholars

Argument Summary: The California Supreme Court should reach the merits and reverse the appeals court’s decision. Medicaid is designed to provide low-income Americans with timely health care, not merely coverage. Poverty and poor health are inextricably linked. Federal law defines Medicaid as healthcare itself, not simply a means to pay for care. Federal regulations implementing the prompt assistance statute must be read in light of Medicaid’s underlying purpose to provide actual healthcare. CMS policy makes clear that enrollment surges are not unusual circumstances that justify delay.

Outside Counsel: Olson Remcho LLP