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."

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