When will I have to pay?

  • July 24, 2021

A federal judge ruled that California must pay $2.2 million to a disabled woman who claimed that the state’s Medicaid program failed to pay for the cost of her son’s birth because of an inaccurate payment history.

In a ruling published Monday, U.S. District Judge Richard Berman said that the Medicaid program did not adequately cover the cost and that the California Department of Social Services was responsible for providing the payment.

He also said the state had not properly identified the “critical deficiencies” in its Medicaid program, which provides medical and dental care to people who are unable to work because of disabilities.

“This is an egregious example of a state attempting to avoid paying its Medicaid enrollees a living wage,” Berman said.

“It is not just an egregious violation of federal law, it is a deliberate attempt to evade federal laws by denying Medicaid eligibility to thousands of eligible Californians.”

Berman wrote that the woman’s lawsuit was not based on any federal or state law.

The ruling came after a series of challenges to the California program from California employers and advocates who argued that the program was designed to make the state “competitive” against the private health insurance market.

The program has a $3,500 cap for the first two months of coverage.

The state has argued that it should have had the cap on the first month to avoid creating “unnecessary hardship.”

But Berman said the program did have an incentive to be stingy, since many people who enrolled did not qualify for the benefit for months.

“The program was structured to be overly generous to the beneficiaries, who in turn were encouraged to enroll, and to pay a disproportionate share of their premium to their employer for the privilege of providing this benefit,” Berman wrote.

The judge added that California was able to keep the cap because of the lack of a “compromise” on Medicaid reimbursement to states for providing coverage to the eligible population.

He ruled that the department must pay the woman $2,225,000 for the costs of caring for her son who was born with a severe birth defect, which caused him to have cerebral palsy and a partial disability.

The state had previously paid her $1.9 million for the medical and medical care of her child, but the court said that was insufficient.

The case was filed by the California chapter of the American Civil Liberties Union.

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