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OUI
SUPERIOR COURT OF CALIFORNIA
COUNTY OF SAN FRANCISCO
Document Scanning Lead Sheet
Jan-04-2013 10:45 am
Case Number: CPF-09-509847
Filing Date: Jan-04-2013 10:45
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DECLARATION
MARIA MARGUEZ VS. CALIFORNIA DEPARTMENT OF HEALTH CARE
SERVICES et al
001C03894514
Instructions:
Please place this sheet on top of the document to be scanned.Bay Area Legal Aid
Michael Keys, State Bar No. 133815
1035 Market Street, Sixth Floor
San Francisco, CA 94102
T: (415) 982-1300, ext. 633
F: (415) 982-4243
mkeys@baylegal.org
Western Center on Law and Poverty
Robert Newman, State Bar No. 86534
3701 Wilshire Blvd., #208
Los Angeles, CA 90010
T: (213) 487-7211
F: (213) 487-0242
rmewman@welp.org
Youth Law Center
Alice Bussiere, State Bar No. 86534
San Francisco, CA 94104-2741
T: (415) 543-3379
F: (415) 956-9022
abussiere@ylc.org
Attorneys for Petitioners
(continued on next page)
IN THE SUPERIOR COURT OF THE STATE OF CALIFORNIA
COUNTY OF SAN FRANCISCO
MARIA MARQUEZ, MARICELLA RIVERA,
ROBERT PLANTHOLD,
Petitioners,
vs.
DEPARTMENT OF HEALTH CARE
SERVICES, TOBY DOUGLAS, Director
Of Department of Health Care Services
(FORMERLYDAVID MAXWELL-
JOLLY), DOES 1-20,
Respondents.
DECLARATIONS ISO PEREMPTORY WRIT
Case No. CPF-09-509 847
DECLARATIONS IN SUPPORT OF
PETITIONERS’ MOTION FOR
PEREMPTORY WRIT
Hearing Date: March 6, 2013
Hearing Time: 9:30 a.m.
Dept.: 302
CASE NO. CPF-09-509 8471 Lucy Quacinella, State Bar No. 99535
2 || Multiforum Advocacy Solutions
275 Fifth Street, Suite 414
3 || San Francisco, CA 94102-4120
T: (415) 348-6336
F: (415) 541-8588
lucyqmas@gmail.com
4
5
6 Neighborhood Legal Services of Los Angeles County
7 {| Catherine S. Murphy, State Bar No. 212441
13327 Van Nuys Blvd.
8 || Pacoima, CA 91331
T: (818) 492-5247
9 || F: (818) 896-6647
0 katiemurphy@nls-la.or,
28 DECLARATIONS ISO PEREMPTORY WRIT CASE NO. CPF-09-509 847Petitioners hereby submit the following Declarations (in alphabetical order) in
support of Petitioners’ Motion for Peremptory Writ of Mandate:
Declaration of Iva Hong
Declaration of Cristina Jones
Declaration of Maria Marquez
Declaration of Virginia Ochoa
Declaration of Maricella Rivera
Declaration of Ana Valenzuela
Declaration of Celia Valdez
DATED: January 2, 2013
DECLARATIONS ISO PEREMPTORY WRIT
Exhibit 1
Exhibit 2
Exhibit 3
Exhibit 4
Exhibit 5
Exhibit 6
Exhibit 7
—-/
Lucy ouch
Attorney for Petitioners
\
CASE NO. CPF-09-509 847DECLARATION OF IVA HONG
I, IVA HONG, hereby declare that, if called as a witness, I could and would competent
testify to the following:
1. I work for the Center for Health Care Rights (CHCR) a non-profit organization in Los|
Angeles that provides assistance to Medicare and Medi-Cal beneficiaries.
2. Ihave worked for CHCR for over five years. Among the many services that CHCR
provides to low-income families is assistance enrolling and disenrolling in Medi-Cal and
navigating the Medi-Cal system to obtain timely access to medical care.
3. Ihave worked primarily with clients who are dually eligible for both Medicare and
Medi-Cal (“dual eligibles”) for approximately two years. Dual eligibles are low income seniors
over the age of 65 or are persons under the age of 65 that have severe disabilities. To receive
both Medicare and Medi-Cal, dual eligibles must both be over the age of 65 or severely disabled
and additionally, meet the low income and asset requirements for full Medi-Cal.
4. We have experienced problems with correcting Other Health Coverage (OHC) codes
that incorrectly appear on beneficiaries’ Medi-Cal record. As instructed by the DHCS, we are
currently submitting our requests for code corrections to the beneficiaries’ Medi-Cal record to
the “Wats” email address, wats@dhcs.ca.gov, and we have also been using a new web based
system that DHCS has referred us to.
5. The dual eligible beneficiaries that contact CHCR are often experiencing urgent
access to care issues. For example, I have assisted several beneficiaries who have been unable to
obtain diabetic supplies because of the incorrect OHC code. When a beneficiary is experiencing
an urgent access to care issue we will indicate that the request for OHC code removal is urgent.
6. The primary problem that we see is long delays in the correction of Medi-
Cal records to delete the incorrect OHC code for clients with urgent medical needs, or sometimes
even no correction after repeated requests. For example, an urgent request that I submit to
correct a beneficiary’s record because they are experiencing access to care issues will not be
corrected for weeks leaving the beneficiary unable to receive services. At times we have to27
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submit three or four requests over the span of several weeks and call OHC staff directly before
the OHC code is corrected. In addition to delays obtaining diabetic supplies, beneficiaries that
have assisted have not been able to see their doctor and have had problem obtaining incontinence
supplies because of these delays.
7. The delay in removal of the OHC code can interfere with access to doctors’ visits and|
other medical care and may cause the beneficiary’s condition to worsen or further exacerbated
their symptoms. A beneficiary that cannot obtain their diabetic or incontinence supplies because
of the OHC code must either find the money to pay for the supplies or go without their supplies
until the code is corrected. The beneficiaries that I assist generally live on approximatel
$835.00 per month and do not have the means to pay for the supplies, so they go without unti
the OHC Code is corrected.
8. The second problem that we see is the incorrect OHC code reappears repeatedly on
beneficiaries’ records. Specifically, we request an OHC code removal and one month later the
beneficiary is experiencing access to care issues again because the same code is appearing on
their record again. We must then request the OHC code removal and the beneficiary’s access to|
care is delayed again.
I declare under penalty of perjury under the laws of the State of California that the
foregoing is true and correct. Executed on (- at [~wO , in Los Angeles County.
California.
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DECLARATION OF CRISTINA JONES
I, CRISTINA JONES, hereby declare that, if called as a witness, I could and
would competently testify to the following:
1. My son Elijah is nine-years old and has a genetic disability, called Anhydrotic
Ectoderal Dysplasia, or AED. Basically, AED means Elijah has no sweat glands.
Although AED is a terrible condition, Elijah was able to obtain necessary medical care
when he had Medi-Cal. But Elijah’s Medi-Cal coverage was cut off without any warning
in the Spring of 2010 as he supposedly had other health coverage through a Blue Cross
HMO. I am submitting this declaration because Elijah was unable to receive medical
care he badly needed for about six months until we finally got his Medi-Cal coverage
restored. It is no exaggeration to say that this almost cost him his life.
2. I was born in California and have lived worked in the state for many years. My
father retired from the military in California. I am the single mother of three children.
Besides Elijah, I have two girls, Joy, age 12, and Trinity, age four.
3. Elijah has been receiving Supplemental Security Income (SSI) due to his
disability ever since age three.
4. Allkinds of terrible things happen to Elijah’s body because he lacks sweat glands.
He has suffered ever since he was born and spent much of his life as a baby and toddler
going in and out of hospitals.
5. For example, because of the AED, Elijah’s T-cells are different from normal ones,
and this makes him very vulnerable to infection. Cuts, scrapes, openings in the skin of
any kind can be very dangerous to him, they make him susceptible to staph infections. He
gets ear and other kinds of infections a lot. He frequently has to take antibiotics to
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prevent or control infections. He has become resistant to some antibiotics and has been
hospitalized several times for staph infections.
6. Elijah’s teeth don’t grow in, or grow slowly and poorly, because of the AED.
He’s 9 years old now but only has seven teeth, and these are malformed. He needs gum
reconstruction so that dentures can eventually be fit for him. In the meantime, Elijah’s
oral health condition creates difficulty with his speech, and it makes eating many kinds of
food difficult if not impossible. Elijah’s diet consists only of soft foods, and I and his
doctors have to keep watch on his nutrition and whether he’s gaining enough weight for
his age.
7. Elijah gets nose bleeds a lot, his throat is sore and raspy most of the time, and he
is at risk for serious eye problems, like glaucoma, because of the AED.
8. The AED also makes his nails and skin very thin. He breaks out in severe eczema
easily if it is not controlled with medication. The eczema makes his skin very sensitive,
flakey and itchy, it gets red and inflamed, the skin rises up and gets infected easily. To
control the eczema, we have been applying topical steroid creams to his skin, ever since
he was a baby. These creams require a prescription. These drugs can, however, cause
cancer, so he has to be monitored regularly by a doctor to see if any bad side effects are
developing from the treatment to control his eczema.
9. Elijah was diagnosed with attention deficit hyperactivity disorder (ADHD)
several years ago. He takes a prescription medication for his ADHD, called Adderall.
Late last year, he was also diagnosed with mood disorder and explosive personality.
Elijah needs weekly individual therapy sessions with a psychiatrist, he started weekly
therapy with a psychiatrist when he was about eight years old.
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10. I met the father of my three children in high school. We separated in 2007 and
have not communicated at all in the past four years. He was extremely emotionally
abusive to me, I was terrorized with death threats and in other ways. Although we were
never married, I did get support orders for each of the kids we separated; my parents
insisted that I get a court order when my first child, Joy, was born. I later asked the court
to add Elijah and then Trinity to the court order after their births. My whereabouts are
not disclosed in the orders so that my ex cannot come after me. As it turns out, I haven’t
collected much in child support from the kids’ father over the years, in many years none
at all, and I don’t know where their father is now.
11. I attended Laney College in Oakland for one year. I received my Bachelor of
Science degree in Psychology from Texas Wesleyan University in 2008. My mother lives
in Oakland now. I have been moving back and forth between California and Texas most
of my life. My dad was from Texas, and a lot of our family is still in Texas. Dad came
to California with the Army; he retired from the Army in about 1989. My brother just
retired from the Army in 2010. I guess you could say we are an Army family. Dad was
one of Elijah’s primary caregivers for many years, until he died in 2007. Dad’s passing
was a huge blow to both Elijah and me.
12. From about 2008 to about the end of 2010, we lived in Alameda County, first in
Hayward, then Oakland, and finally Concord. I was in school full time, working on
getting my Masters Degree in Marriage and Family Therapy at JFK University in
Pleasant Hill. I also had a full time job as a mental health counselor at the Seneca
residential facility in Concord. Seneca serves severely emotionally disturbed youth and
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other youth with serious mental health conditions. As my job didn’t pay much, Elijah
continued to qualify for SSI.
13. Elijah and my two daughters also qualified for Medi-Cal. With his Medi-Cal,
Elijah was regularly seen at a clinic in Piedmont that is part of Oakland Children’s
Hospital. I would drive all the way over from Concord because it is so hard to find a
doctor who knows about Elijah’s condition, which is pretty rare. Elijah had a primary
care doctor at this clinic, Dr. Pamela Sims-Mackey, who monitored his AED and
symptoms, prescribed Elijah’s topical skin creams and checked up on their impacts,
provided normal childhood care, like immunizations, and prescribed and monitored his
ADHD medications. I also took Elijah to this clinic when he got sick. When it was an
emergency, I would take him to the Emergency Room at Oakland Children’s Hospital.
14. Dr. Sims-Mackey also arranged for Elijah to be seen with Medi-Cal by a panel of
genetics specialists at UCSF Children’s Hospital in San Francisco. | think it was around
spring time in 2010 that I took Elijah there. He was seen by an opthamologist, an ear,
nose and throat specialist, a speech pathologist, and an cranial-facial surgeon. After this
visit, which took most of the day, a referral was made for further consultation with a
cranial-facial surgeon so that Elijah could eventually get have his gums reconstructed and
get dentures.
15. Before spring of 2010, we had no problems with Elijah’s Medi-Cal coverage. But
then one day sometime after his visit with the specialists at UCSF, when I took him to the
Piedmont clinic for a medical appointment, they told me they could not use Elijah’s
Medi-Cal anymore because his Medi-Cal file showed he had other coverage. They didn’t
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tell me what the other coverage was. I was shocked. Elijah didn’t have any coverage
other than Medi-Cal, he’s never had any other coverage, other than Medicaid in Texas.
16. The same thing happened when I went to the clinic’s pharmacy that same day to
try fill the prescription for Elijah’s medications. The pharmacy said Medi-Cal wouldn’t
cover Elijah anymore, that his file showed he had other coverage.
17. It also happened when I took Elijah to his next weekly individual therapy with his
psychiatrist. They said his Medi-Cal file said he had other coverage and they couldn’t see
him anymore as a Medi-Cal patient. They said they would give him two more therapy
sessions for free, but that was it. This was a huge blow to Elijah because he had become
very close to this psychiatrist.
18. I never received anything in writing from Medi-Cal or anyone else saying that
Elijah supposedly had other coverage. Nobody told me who the other coverage was,
nobody gave me a policy number for the other coverage Elijah supposedly had or told me
where to go to get him medical care with his other coverage. I had no way to contact my
ex to see if he knew what this might be about. And I never got anything from Medi-Cal
saying how I could appeal or get the other coverage off Elijah’s Medi-Cal file.
19. I tried for months to figure out how to get Elijah’s Medi-Cal back. I contacted a
social worker at Oakland Children’s Hospital. She contacted the Medi-Cal program and
told me that Elijah’s other coverage was supposedly a Blue Cross HMO. She said the
only way I could get this off Elijah’s Medi-Cal file was to prove he did not have Blue
Cross. I asked for but received no further help from her. The same thing happened when
I contacted Elijah’s eligibility worker at Alameda County. She just told me I needed to
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get proof in writing that Elijah didn’t have other coverage, she said he would have to use
Blue Cross until then.
20. I found a phone number for Blue Cross on my own. I asked if they could give me
a print out or just anything else in writing to show that my son did not have a Blue Cross
policy. They wouldn’t give me anything in writing, and they said they couldn’t issue a
start or end date of coverage because I had no policy number. Of course, I had no policy
number because Elijah had never been covered by Blue Cross. Blue Cross did say that
they would be willing to talk with anyone from Medi-Cal who called them, but that was
no help to me because the two social workers I talked with said the proof had to be in
writing.
21. A little while after this, Elijah got a bad ear infection, so I took him to the
Emergency Room at Oakland Children’s Hospital. They saw him for free there and gave
him some antibiotics.
22. But there was so much more medical care he needed that we couldn’t get for him
during a period of about six months in 2010 when the Blue Cross HMO was in his Medi-
Cal file and I didn’t know what more to do to try to get it off. I didn’t follow up with the
cranial-facial surgeon for the additional consultation recommended by the geneticists
panel at UCSF Children’ Hospital for the gum reconstruction Elijah needed, so he could
get dentures. I knew I couldn’t use Medi-Cal and I had no way to pay for such expensive
services.
23. There was no way I could afford to buy Elijah’s medications. The steroid skim
creams alone that Elijah needs cost hundreds of dollars a tube. Without his prescription
creams, Elijah broke out in horrible eczema and was in extreme pain and discomfort. He
6
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hurt and itched all over, he couldn’t sleep, he was agitated. I was deathly afraid he’d get
another staph infection and have to be hospitalized. He still has scars all over his body
from that time in 2010 when I couldn’t afford to buy his medications and Medi-Cal
would not cover them because his file said he had other coverage.
24. I couldn’t afford his ADHD medications, either; they also cost much more than I
could pay, around $ 200 for a month worth of pills for him. Off his meds, not able to see
his psychiatrist anymore, and suffering horribly from eczema, Elijah went completely
downhill emotionally and mentally. He became very aggressive and disruptive, throwing
major tantrums frequently. His behavior was out of control, both at home and at school.
25. Things got so bad that I had to quit my Masters program and also my counselor’s
job at Seneca to take care of my son full time.
26. In October 2010, I took my daughter Trinity to the Piedmont clinic. There
was no problem with her Medi-Cal, and she was seen that day by the doctor. My
daughter had the same primary care doctor as Elijah had, Dr. Sims-Mackey. The doctor
asked me how Elijah was doing and why I hadn’t brought him in for a medical visit in so
long. When I told her about Elijah’s deteriorating condition and that I had to stop taking
him to see her because of the problem with the private Blue Cross HMO showing up in
his Medi-Cal file, she referred me to the East Bay Community Law Clinic (EBCLC) in
Berkeley.
27. EBCLC helped me get the Blue Cross HMO off Elijah’s Medi-Cal, I think it was
sometime shortly after I spoke with Dr. Sims-Mackey in October 2010. But by then, I
had decided to move back to Texas and was getting my children’s Medicaid and Elijah’s
SSI transferred there. I had lost hope that things could ever get fixed with his Medi-Cal,
7
DECLARATION OF CRISTINA JONES ISO MOTION FOR WRIT OF MANDATE
CPF 09-509847and I was worried that even if there was a fix, the Blue Cross might pop up in his Medi-
Cal file again. I had never had a problem using Elijah’s Medicaid card in Texas.
28. I was able, thankfully, to use Elijah’s Medi-Cal again before we left for Texas. I
got his skin creams right away, and his ADHD medication. I probably also took him in
to see the doctor.
29. But it took a long time to get him stabilized. It takes time to readjust to the
ADHD medications and for them to build up in his system the right way. He continued
to have major problems even after we moved back to Texas in December of 2010, to the
point that he started physically hurting himself. It was so horrible to watch my son
deteriorate to that point. I had to have my son admitted to an in-patient psychiatric
hospital to protect himself. This happened in February 2012. The hospital is called
Millwood Hospital; it is located in Arlington, Texas.
30. My children and I now live in Fort Worth, and I am back in a Masters program in
Marriage and Family Therapy at Texas Wesleyan University. I’m also working full time
again as a counselor for severely emotionally disturbed youth. My employer is a private
company that has a contract to provide mental health services to at risk youth for Tarrant
County through the Texas Medicaid program.
31. The Blue Cross HMO has never come up on Elijah’s Medicaid file in Texas.
32. It has taken about a year to get Elijah’s medical and mental health situation under
control. With his Texas Medicaid, he is back in weekly mental health therapy sessions
with a psychiatrist, I am able to fill his prescription medications, he has a primary care
doctor again who monitors his condition, and we are on track to get his gum
reconstruction and then dentures.
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33. Even though I live in Texas now, I hope that no other child or person with Medi-
Cal to ever has to go through what my son suffered when he lost access to his Medi-Cal
coverage. It was so painful for Elijah and our family. I have a college education and I’ ve
been working in the mental health field with families whose coverage is through
Medicaid; I can only imagine how much harder it must be for families who don’t have
my experience and background to try to figure out what to do when the state claims a
person with Medi-Cal also has some other private insurance that they don’t actually have
and that they can’t use.
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DECLARATION OF CRISTINA JONES ISO MOTION FOR WRIT OF MANDATE
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I declare under penalty of perjury under the laws of the State of California that the
foregoing is true and correct. Executed on Yl 20012, in Forth Worth, Texas.
CRISTINA J Ss
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DECLARATION OF CRISTINA JONES ISO MOTION FOR WRIT OF MANDATE
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DECLARATION OF MARIA MARQUEZ
I, Maria Marquez, hereby declare that I have personal knowledge of the following
facts and that, if called as a witness, I could and would competently testify thereto:
1. I live in San Francisco, California, with my son, J. O., who was born in 2001. He
is 11 years old.
2. J.O.’s father and I separated around 2005 because of severe domestic violence.
The doctors and counselors who have seen my son since the separation have told me that
he needs individual therapy to help him deal with the domestic violence that went on
before the separation.
3. Soon after his father and I separated, J.O was evaluated for whether he needed
mental health services. This was done at San Francisco General Hospital (SFGH), they
have a program there that helps children who have witnessed severe violence. After a
while, he saw a therapist named Erica Torres. I don’t remember exactly when this was,
but it was a few years ago.
4. After a while, Erica Torres told me that she was leaving the SFGH and she
referred me to an agency called Access to get a referral for Medi-Cal to pay for a
therapist for J.O.
5. Icalled the Access telephone number and they arranged for J.O. to see a therapist
named Norma Aguilar for individual therapy once a week.
6. J.O. saw Ms. Aguilar for individual therapy sessions about two times. She also
came to J.O.’s school about two times to observe him.
7. After about two individual sessions at her office, Ms. Aguilar told me that J.O.
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would have to stop coming to see her because Medi-Cal would not pay for the therapy
sessions since we had Kaiser health insurance. Soon after that I got a telephone call from
aman who said he was from Access. He also told me that J.O. would have to go to
Kaiser for his therapy. The Kaiser health insurance is from his father’s employment.
8. I did not receive any written notice from Medi-Cal or Access or anyone else that
Medi-Cal would stop paying for his therapy because J.O. had Kaiser health insurance.
My son did not receive any written notice like that, either. We were never told that we
had the right to challenge the decision to stop Medi-Cal paying for J.0.’s individual
therapy.
9. 1 tried taking J.O. to Kaiser for his mental health therapy but it did not work.
First. Kaiser did not offer J.O individual therapy, which is what he had been getting at
SFGH and through Medi-Cal from Ms. Aguilar. Instead, Kaiser offered him some family
therapy and group sessions with other children.
10. Also, the Kaiser building where the mental health services were provided
was far away from our home. It always took about 70-90 minutes to get there. The
round trip was often three hours. We had to travel by San Francisco MUNI bus, and the
trip took three different buses to get there and three to get back home. Because of the
amount of time it took to get to the Kaiser building, J.O. had to leave school early, which
was causing problems. J.O.’s father took him sometimes but not always. Whenever I
took him, we had to travel by bus.
11. Kaiser also charged for each visit and prescription medication. Medi-Cal
has not charged for these. At first I tried to pay the Kaiser charges but eventually I could
not afford them.
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12. After a few visits, a Kaiser doctor prescribed a medication to help my son
sit still and pay attention. The first time I filled the prescription, Kaiser charged me about
$150. I paid with my credit card. The second time, Kaiser charged me about $85. I
could not afford these charges so I stopped getting the prescriptions filled.
13. Kaiser also charges for services other than prescription medications. The
co-payments for the family counseling and group counseling were about $20 per session.
14. Because of the problems getting to the Kaiser mental health services, the
fact that there was no individual therapy, and the costs, I stopped taking J.O. to Kaiser for
mental health services.
15. During this time, J.O. seemed to get worse. He had problems concentrating and
remembering things. He had a hard time doing his homework and was easily frustrated.
His teachers called me during this time and said it was hard to keep him focused and he
would not sit still. He wet his pants because a teacher thought he was just fidgeting when
really he had to go to the bathroom.
16. Also, during this time, Bay Area Legal Aid was helping me in Family Court.
When I told them about the problems I was having getting J.O.’s mental health services
and medications, they helped here too. They helped me get Medi-Cal to start covering
his individual therapy and medications again.
17. J.O. is still in weekly individual therapy at the Mission Family Center in
San Francisco. He still takes medication to help him sit still and pay attention in school
so he can learn and not fall behind. Medi-Cal is covering the therapy and medicines so I
do not have to worry about charges for mental health services and medications that I
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CPF 09-509847cannot afford. The Center is closer to our home and J.O.’s school, so it does not take so
long to get there and he does not have to skip school to get there on time.
18. J.O. continues to suffer from attention problems and anxiety, but he has
been doing much better in school and at home since we got his Medi-Cal back and he is
getting his weekly individual mental health therapy again and his medication. The
medication has side effects. My son loses his appetite and eats very little when he takes
his medication. He also has trouble sleeping when he takes the medication. Because of
the side effects, the doctor gave me the option not to give my son his medication when he
is not in school. To give J.O. relief from the side effects, I do not give J.O. his
medications on weekends or during school holidays and school breaks.
19. I could not have managed on my own to get my son’s Medi-Cal back for
his individual health therapy and medication without Bay Area Legal Aid’s help. I don’t
want any other family to have to go through what I went through with J.0.’s Medi-Cal
being blocked and not being able to get the therapy and medication that J.O. needed. It is
terrible as a mother to watch your child suffer and not know how to help him feel better.
20. This declaration was translated to me in Spanish by Maria Frias at Bay Area
Legal Aid.
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DECLARATION OF MARIA MARQUEZ ISO MOTION FOR WRIT OF MANDATE
CPF 09-509847I declare under penalty of perjury that the foregoing is true and correct. Executed on
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Maria Marquez
DECLARATION OF MARIA MARQUEZ ISO MOTION FOR WRIT OF MANDATE
CPF 09-509847kuhPov snarion OF VIRGINIA oo
I, Virginia Ochoa, hereby declare that, if called as a witness, I could and would
testify to the following:
1. 1 live in Littlerock, California. Maricella Rivera is my granddaughter.
In 2009, Maricella and her brother, Mario Rivera, were living with me, their legal
guardian. They both had Medi-Cal and also Kaiser, through their father.
2. In August of 2009, Maricella’s prescription glasses were broken. She was
cighteen years old at the time. I couldn’t afford to buy her another pair. I tried to get her
another pair of glasses with her Kaiser and her Medi-Cal but neither one of those would
work. It took about three months before Maricella got new glasses through Medi-Cal, and
it was only with help from the Health Consumer Center in Pacoima that this happened.
Because Maricella’s eyesight is so bad, she had a real hard time in school and pretty
much everywhere else during those three months without proper eyeglasses.
3. After Maricella’s glasses were broken, I took her to Kaiser in Lancaster to
try to get her new eyeglasses, but Kaiser said Maricella’s plan didn’t include eyeglasses.
Actually, [ wasn’t surprised, because Mario’s glasses had broken a few months before
and Kaiser wouldn’t cover his glasses. | had to pay for them on my own; it was really
expensive.
4. I couldn’t afford to buy glasses for Maricella, so I took her to a Medi-Cal
optometrist to try to get her a pair of glasses with her Medi-Cal card. But the optometrist
said I had to take Maricella to Kaiser for the glasses because her Medi-Cal file showed
she supposedly had Kaiser for everything.
5. So then I tried another Medi-Cal optometrist. The same thing happened there:
Maricella’s Medi-Cal was not accepted because her Medi-Cal file said she had Kaiser for
everything.
6. After that, | contacted the Health Consumer Center at Neighborhood Legal
Services in Pacoima. They had helped me before when Maricella had a problem using
Medi-Cal for dental services, so I thought I would try them again. The Health Consumer
DECLARATION OF VIRGINIA OCHOA ISO MOTION FOR WRIT OF MANDATE
CPF 09-509847oe NY DH nH BF BW N
NN NY NY NY N NN DY HB Se Bee Be eB Be ewe ee
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Pcusration OF VIRGINIA oc
Center helped me get the glasses for Maricella with Medi-Cal. But that didn’t happen
until late October, almost three months after her glasses got broken in August.
7. When Maricella was turned away from Medi-Cal for glasses, we didn’t get
any notice in writing telling us what to do to be able to use her Medi-Cal for glasses if
Kaiser didn’t cover glasses for her.
8. Without the Health Consumer Center, I don’t think I would ever have been able to
figure out how to get new glasses with Medi-Cal for Maricella. I had been trying on my
own, going back and forth between Medi-Cal optometrists and contacting Kaiser, but that
didn’t work. I don’t want other families to have the same problems, not for any of their
medical care.
9. Maricella’s eyesight is very poor. The taped up glasses she had to wear for about
three months until we could get her new glasses through Medi-Cal didn’t fit her right,
they were all crooked. Also, one of the lenses was chewed up by a dog. So she hada
terrible time trying to read and pay attention at school and she got a lot of headaches until
her glasses got fixed. She also said she felt embarrassed wearing the taped up glasses,
especially around other kids.
I declare under penalty of perjury that the foregoing is true and correct. Executed
on s J. 20 , 2012, in Los Angeles County, California.
\Ga ma Oc fora
rginia Ochoa
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DECLARATION OF VIRGINIA OCHOA ISO MOTION FOR WRIT OF MANDATE
CPF 09-509847pM aration OF MARICELLA iv
I, Maricella Rivera, hereby declare that, if called as a witness, I could and would
testify to the following:
1. I live in Littlerock, California. I am 21 years old now. In 2009, I was 18 and
living with my grandmother who had taken care of me for several years.
2. In August of 2009, my glasses were broken. I was staying the night at my aunt’s
house. While I was sleeping, her dog grabbed my glasses off a coffee table and chewed
them up, damaging one of the lenses and the frames. So I got a pair of old sunglasses,
took out the dark plastic lenses, and taped in my prescription lenses, it looked very weird.
I was very self-conscious about how my glasses looked, especially when | was in public
or around other teenagers, like when I started back at school. It was embarrassing, I had
enough problems being a foster kid; looking weird was another blow to my self-esteem,
to my feelings that my parents didn’t want me, it added to my insecurity. It may not seem
like a big deal to an adult, but to me it was very upsetting and affected my moods, my
ability to concentrate or socialize with other people.
3. Plus, these makeshift glasses didn’t sit right on my face and felt like the sides
were cutting into my face. I couldn’t see out of the lenses very well especially the lens
that got chewed up. I kept having to try to place the lenses right, which I never managed
to do, so I got headaches with the glasses on or off and I couldn’t see very well. I have
worn glasses for as long as I can remember, ever since I was a little kid. My eyesight is
really bad. I need glasses for everything, for seeing far away, for reading, looking at the
blackboard when I was in school, for doing just about anything. I sometimes bump into
things when I don’t have glasses on, my eyesight is that bad.
4, I had Medi-Cal at the time my glasses broke. I also had a Kaiser card from my
father’s insurance. My grandmother tried to get me new glasses with my Medi-Cal but
the Medi-Cal wouldn’t work because of the Kaiser. So I went without proper glasses for
about three months, until October, when the Health Consumer Center helped me be able
to use my Medi-Cal again.
I
DECLARATION OF MARICELLA RIVERA ISO MOTION FOR WRIT OF MANDATE
CPF 09-5098471M aranion OF MARICELLA Pea
1/5. If I didn’t have an advocate at the Health Consumer Center, I don’t think my
2 || grandmother and I would ever have been able to figure out how to get my new glasses
3 || with Medi-Cal. I don’t want other kids to have the same problems, not for any of their
4 || medical care.
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6 I declare under penalty of perjury that the foregoing is true and correct. Executed
“th
7 {jon May xD > 2012, in Los Angeles County, California. .
8
9 Maricella Rivera
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DECLARATION OF MARICELLA RIVERA ISO MOTION FOR WRIT OF MANDATE
CPF 09-509847Fw oN
DECLARATION OF ANA VALENZUELA
I, ANA VALENZUELA, hereby declare that, if called as a witness, I could and
would testify to the following:
1. I work for a non-profit organization in Los Angeles, called Maternal and
Child Health Access (MCH Access). I have worked as an outreach worker for MCH
Access for about 14 years. I help low-income families in Los Angeles County enroll in
Medi-Cal and other health programs, and I also help them fix problems that come up so
that they can get access to medical care with their Medi-Cal. I handle an average of
about 35 cases a month.
2. Many of my cases involve women and children who cannot access Medi-Cal
services because their Medi-Cal files are linked mistakenly to Other Health Coverage
(OHC) that the clients do not have. I get at least one new case of this type a week, and
many weeks, I get two or three such cases. When a person’s Medi-Cal file is marked
with OHC, delays in getting Medi-Cal services can happen. Such delays can be very
dangerous, depending on the client’s health circumstances; even a short delay of a few
days can be very harmful. Two recent examples are described below. These examples
are, unfortunately, not unique.
3. On January 23, 2012, I was contacted by a pregnant woman who said she was
going to have her baby in about two weeks and needed help getting to use her Medi-Cal
for prenatal care and for the hospital to deliver the baby. She said she had recently gone
to South Bay Community Family Health Care in Torrance, California for prenatal care,
but they would not see her with Medi-Cal because OHC showed up in her Medi-Cal file.
South Bay referred the woman to MCH Access for help getting the OHC removed.
DECLARATION OF ANA VALENZUELA ISO MOTION FOR WRIT OF MANDATE
CPF 09-5098474. I checked the woman’s file on-line in AEVS, which is Medi-Cal’s Automatic
Eligibility Verification System; community organizations, like MCH Access, can get
state approval to access the AEVS system. The AEVS report (Exhibit A to my
declaration) said the client had OHC. But the client said she didn’t have OHC of any
kind. She also said that before she went to South Bay no one had told her that she
supposedly had OHC. She had no idea why anyone would think she had OHC. I called
the clinic; they confirmed they would not see her because of the OHC.
5. Usually, when I have a client who is having a problem using her Medi-Cal
because her file says she has OHC when she doesn’t have OHC, | start by sending the
state an e-mail, asking that the OHC be removed. But it often takes several days or even
several weeks or more before I get a response from the state to these e-mails.
6. So in this case, because the client was so close to having her baby and couldn’t
get any prenatal care through Medi-Cal, instead of e-mailing I telephoned the State
Department of Health Care Services (DHCS) in Sacramento to ask that the client’s OHC
be removed on an urgent basis. I made this call the same day the client contacted me,
January 23, 2012. The person I spoke with identified himself as James Riley. He said he
would remove the OHC. The next day, January 24, the client’s file showed OHC was
removed (see Exh. B), and the client was able to be seen with Medi-Cal at South Bay for
prenatal care.
7. On February 24, 2012, the client contacted me again. Her baby had been born by
C-section. When she went to South Bay on February 17, 2012 for her scheduled post-
partum appointment to have the staples removed, the clinic would not see her because the
same OHC had returned to her Medi-Cal file. On the same day the client contacted me,
DECLARATION OF ANA VALENZUELA ISO MOTION FOR WRIT OF MANDATE
CPF 09-509847PB wWoN
February 24, 2012, I sent an e-mail message to State DHCS, marked “Urgent”, to ask that
the OHC be removed again.
8. The client called me again the afternoon of February 29, 2012. I checked AEVS,
and the client’s Medi-Cal record still showed the OHC (see Exh. C). By then, the client
was in terrible pain and discomfort, I could tell by how she sounded over the phone. She
said she was taking painkillers and also that she was very worried that she was getting an
infection from the staples. I discussed the case with my supervisor at MCH Access, Celia
Valdez. I understand that Celia contacted Lucy Quacinella.
9. The next morning, March 1, 2012, Lucy informed me that DHCS said it had
taken care of the client’s OHC code problem, but that the change would not show up in
the client’s Medi-Cal file until the following day, March 2. I contacted the provider,
South Bay, the morning of March 1, 2012 and explained that the OHC was being
removed. | asked the provider to see the client that same day, March 1, because she
seemed to be in such bad shape. But they said no, she would have to wait until 8:30 a.m.
the following day, that she could not be seen as a Medi-Cal patient until her Medi-Cal file
showed the OHC was removed. So I made an appointment for the client for 8:30 a.m.
March 2, 2012.
10. When I spoke with the client again on March 1, 2012, around noon, she
said she was in so much pain that her husband had helped her pull out two of the staples
by hand. She explained to me that they were very worried about infection because of the
pain and because she had chills and the skin around the staples was swollen and red. She
said there were about 12 more staples left. I discussed the case again with Celia, and -
then contacted the client to recommend that she stop pulling out the staples herself and
DECLARATION OF ANA VALENZUELA ISO MOTION FOR WRIT OF MANDATE
CPF 09-509847instead go directly to the hospital emergency room right away. Her condition sounded
too risky to wait for medical care any longer. She might get a big medical bill from the
emergency room, but we could try to help her address that later.
11. The client called me the next day, March 2, 2012, to let me know she had decided
not to go to the hospital the day before. Instead, she waited and went to her medical
appointment at South Bay the morning of March 2. She said that the doctor told her the
area around the staples had in fact become infected. She said she was given antibiotics to
treat the infection. A follow up appointment was scheduled for March 29, 2012.
12. Unfortunately, that was not the end of this poor client’s troubles with OHC and
Medi-Cal. On Thursday, March 22, 2012, the client called MCH Access and left a
message for me to call her back. I was out of the office March 22 and 23. On Monday,
March 26, 2012, I returned the client’s call. She said that South Bay had contacted her to
report that the OHC had showed up in her Medi-Cal file yet again (see Exh. D) and that
the clinic would not see her on March 29, 2012 unless the OHC was removed by then. .
13. Since the time was so short until the client’s next appointment, I called the DHCS
office in Sacramento on March 26, 2012 instead of sending an e-mail. | left a message in
voice mail for James Riley. I did not get a call back, so on March 29, 2012 I left another
voice mail message for Mr. Riley.
14. I did not receive a return phone call from Mr. Riley or anyone else at state DHCS.
Because OHC was still in the client’s Medi-Cal file, South Bay would not see her on
March 29 and instead re-scheduled her for April 2, 2012. But OHC was still in the
client’s Medi-Cal file on April 2(see Exh. E), and so South Bay still would not see her.
15. On April 3, 2012 I placed a phone call to Robert Bonkowski at DHCS, asking that
4
DECLARATION OF ANA VALENZUELA ISO MOTION FOR WRIT OF MANDATE
CPF 09-509847fw oN
the client’s OHC be removed. He said he would take care of it. I checked the client’s
AEVS file on the following day, April 4, 2012, and I saw that OHC had been removed.
With the OHC removed, the client was seen by South Bay on April 9, 2012. I did not
keep a copy of the AEVS record that I accessed on April 4, 2012 showing OHC was no
longer in the client’s Medi-Cal record.
16. But when I checked AEVS on April 12, 2012, OHC had been reinstated yet
again (see Exh. F). Even after so many phone calls to the state and even a personal call
with Mr. Bonkowski, the OHC keeps returning to this woman’s Medi-Cal file, and I
don’t know what more I myself can try to do to get it permanently removed for her. In
October 2012, the client asked me if the OHC had been removed yet. I checked AEVS
for her, she still had OHC on her Medi-Cal file. 1 used the state’s on-line system to make
yet another OHC removal request for her, on October 10, 2012. It took about two weeks
before the OHC was removed; given the history here | believe it is only a question of
time before the OHC goes back on this client’s file.
17. Another recent case also shows the health access barriers that Medi-Cal
beneficiaries may face when OHC is on their Medi-Cal but they don’t have OHC. On
April 23, 2012, 1 was contacted by a pregnant woman whose estimated delivery date was
May 5. She said she had been receiving prenatal care at Clinica San Miguel but had just
been told that the clinic could no longer see her because her Medi-Cal file was showing
OHC with Kaiser. I ran an AEVS report for her (Exh. G). The woman said she did not
have any OHC, had no idea why the state would think she had Kaiser. The woman
seemed panicked, very stressed out because she did not want to show up at the hospital
uninsured when she went into labor.
DECLARATION OF ANA VALENZUELA ISO MOTION FOR WRIT OF MANDATE
CPF 09-50984718. That same day, April 23, 2012, I sent DHCS an e-mail marked urgent, requesting
that OHC be removed from her file. The OHC was still there the next day, April 24,
2012, so, since this case was so time sensitive, I called Mr. Bonkowski in Sacramento; he
said the OHC would be removed, effective the next day. I was out sick April 25. On
April 26, 2012, I checked AEVS, and the OHC was gone from this client’s Medi-Cal
record (see Exh. H). | also spoke with the client that day—and learned that her baby had
already been born, i.e., before the May 5 estimated due date. If MCHA hadn’t spoken
with Mr. Bonkowski directly, this woman would have been uninsured when she arrived
at the hospital to deliver her baby, which is exactly what she had been trying to avoid. I
am happy we had the expertise and the contacts to help her—but most low-income
women in need do not have an advocate.
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DECLARATION OF ANA VALENZUELA ISO MOTION FOR WRIT OF MANDATE
CPF 09-509847I declare under penalty of perjury under the laws of the State of California that the
foregoing is true and correct. Executed on mH 2012, in Los Angeles County,
California.
DECLARATION OF ANA VALENZUELA ISO MOTION FOR WRIT OF MANDATE
CPF 09-509847
ANA VALENZUELAMedi-Cal: Eligibility Response Ey . f \ Page 1 of 1
Department of
Health Care services QD Meds Cal
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Subscriber County: HIC Number:
19 - Los Angeles
Primary Care Physician Phone #: Service Type:
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Trace Number (Eligibility Verification Confirmation (EVC) Number):
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Eligibility Message:
SUBSCRIBER LAST NAME: EP eve #: 691H9P3P4Z. CNTY CODE: 19. PRMY AID CODE:
3N. MEDI-CAL ELIGIBLE Wi NO SOC/SPEND DOWN. HEALTH PLAN MEMBER: PHP-HLTH NET:
MEDICAL CALL (800)675-6110, HCP: CALL (800) 875-6110 FOR HCP INFORMATION. PCP:
BENJAMIN BEHROQZAN CALL: (323)463-7262. HEALTH NET OF CALIF A, INC: DENTAL
IR CODE V. CARRIER NAME: -
v UNITED HEALTHCARE. COV: V.
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19 - Los Angeles
Trace Number (Eligibility Verification Confirmation (EVC) Number):
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SUBSCRIBER LAST NAME: QQ? EVC #: 131SNSGWGJ. CNTY CODE: 19. PRMY AID CODE:
3N, MEDI-CAL ELIGIBLE W/ NO SOC/SPEND DOWN. HEALTH PLAN MEMBER: PHP-HLTH NET:
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BENJAMIN BEHROOZAN CALL: (323)463-7262. HEALTH NET OF CALIFORNIA, INC: DENTAL
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Preview
OUI SUPERIOR COURT OF CALIFORNIA COUNTY OF SAN FRANCISCO Document Scanning Lead Sheet Jan-04-2013 10:45 am Case Number: CPF-09-509847 Filing Date: Jan-04-2013 10:45 Filed by: Juke Box: 001 Image: 03894514 DECLARATION MARIA MARGUEZ VS. CALIFORNIA DEPARTMENT OF HEALTH CARE SERVICES et al 001C03894514 Instructions: Please place this sheet on top of the document to be scanned.Bay Area Legal Aid Michael Keys, State Bar No. 133815 1035 Market Street, Sixth Floor San Francisco, CA 94102 T: (415) 982-1300, ext. 633 F: (415) 982-4243 mkeys@baylegal.org Western Center on Law and Poverty Robert Newman, State Bar No. 86534 3701 Wilshire Blvd., #208 Los Angeles, CA 90010 T: (213) 487-7211 F: (213) 487-0242 rmewman@welp.org Youth Law Center Alice Bussiere, State Bar No. 86534 San Francisco, CA 94104-2741 T: (415) 543-3379 F: (415) 956-9022 abussiere@ylc.org Attorneys for Petitioners (continued on next page) IN THE SUPERIOR COURT OF THE STATE OF CALIFORNIA COUNTY OF SAN FRANCISCO MARIA MARQUEZ, MARICELLA RIVERA, ROBERT PLANTHOLD, Petitioners, vs. DEPARTMENT OF HEALTH CARE SERVICES, TOBY DOUGLAS, Director Of Department of Health Care Services (FORMERLYDAVID MAXWELL- JOLLY), DOES 1-20, Respondents. DECLARATIONS ISO PEREMPTORY WRIT Case No. CPF-09-509 847 DECLARATIONS IN SUPPORT OF PETITIONERS’ MOTION FOR PEREMPTORY WRIT Hearing Date: March 6, 2013 Hearing Time: 9:30 a.m. Dept.: 302 CASE NO. CPF-09-509 8471 Lucy Quacinella, State Bar No. 99535 2 || Multiforum Advocacy Solutions 275 Fifth Street, Suite 414 3 || San Francisco, CA 94102-4120 T: (415) 348-6336 F: (415) 541-8588 lucyqmas@gmail.com 4 5 6 Neighborhood Legal Services of Los Angeles County 7 {| Catherine S. Murphy, State Bar No. 212441 13327 Van Nuys Blvd. 8 || Pacoima, CA 91331 T: (818) 492-5247 9 || F: (818) 896-6647 0 katiemurphy@nls-la.or, 28 DECLARATIONS ISO PEREMPTORY WRIT CASE NO. CPF-09-509 847Petitioners hereby submit the following Declarations (in alphabetical order) in support of Petitioners’ Motion for Peremptory Writ of Mandate: Declaration of Iva Hong Declaration of Cristina Jones Declaration of Maria Marquez Declaration of Virginia Ochoa Declaration of Maricella Rivera Declaration of Ana Valenzuela Declaration of Celia Valdez DATED: January 2, 2013 DECLARATIONS ISO PEREMPTORY WRIT Exhibit 1 Exhibit 2 Exhibit 3 Exhibit 4 Exhibit 5 Exhibit 6 Exhibit 7 —-/ Lucy ouch Attorney for Petitioners \ CASE NO. CPF-09-509 847DECLARATION OF IVA HONG I, IVA HONG, hereby declare that, if called as a witness, I could and would competent testify to the following: 1. I work for the Center for Health Care Rights (CHCR) a non-profit organization in Los| Angeles that provides assistance to Medicare and Medi-Cal beneficiaries. 2. Ihave worked for CHCR for over five years. Among the many services that CHCR provides to low-income families is assistance enrolling and disenrolling in Medi-Cal and navigating the Medi-Cal system to obtain timely access to medical care. 3. Ihave worked primarily with clients who are dually eligible for both Medicare and Medi-Cal (“dual eligibles”) for approximately two years. Dual eligibles are low income seniors over the age of 65 or are persons under the age of 65 that have severe disabilities. To receive both Medicare and Medi-Cal, dual eligibles must both be over the age of 65 or severely disabled and additionally, meet the low income and asset requirements for full Medi-Cal. 4. We have experienced problems with correcting Other Health Coverage (OHC) codes that incorrectly appear on beneficiaries’ Medi-Cal record. As instructed by the DHCS, we are currently submitting our requests for code corrections to the beneficiaries’ Medi-Cal record to the “Wats” email address, wats@dhcs.ca.gov, and we have also been using a new web based system that DHCS has referred us to. 5. The dual eligible beneficiaries that contact CHCR are often experiencing urgent access to care issues. For example, I have assisted several beneficiaries who have been unable to obtain diabetic supplies because of the incorrect OHC code. When a beneficiary is experiencing an urgent access to care issue we will indicate that the request for OHC code removal is urgent. 6. The primary problem that we see is long delays in the correction of Medi- Cal records to delete the incorrect OHC code for clients with urgent medical needs, or sometimes even no correction after repeated requests. For example, an urgent request that I submit to correct a beneficiary’s record because they are experiencing access to care issues will not be corrected for weeks leaving the beneficiary unable to receive services. At times we have to27 28 submit three or four requests over the span of several weeks and call OHC staff directly before the OHC code is corrected. In addition to delays obtaining diabetic supplies, beneficiaries that have assisted have not been able to see their doctor and have had problem obtaining incontinence supplies because of these delays. 7. The delay in removal of the OHC code can interfere with access to doctors’ visits and| other medical care and may cause the beneficiary’s condition to worsen or further exacerbated their symptoms. A beneficiary that cannot obtain their diabetic or incontinence supplies because of the OHC code must either find the money to pay for the supplies or go without their supplies until the code is corrected. The beneficiaries that I assist generally live on approximatel $835.00 per month and do not have the means to pay for the supplies, so they go without unti the OHC Code is corrected. 8. The second problem that we see is the incorrect OHC code reappears repeatedly on beneficiaries’ records. Specifically, we request an OHC code removal and one month later the beneficiary is experiencing access to care issues again because the same code is appearing on their record again. We must then request the OHC code removal and the beneficiary’s access to| care is delayed again. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed on (- at [~wO , in Los Angeles County. California. Iva pions! OCu ACoe ND HW FW NY Bb = Ss 13 DECLARATION OF CRISTINA JONES I, CRISTINA JONES, hereby declare that, if called as a witness, I could and would competently testify to the following: 1. My son Elijah is nine-years old and has a genetic disability, called Anhydrotic Ectoderal Dysplasia, or AED. Basically, AED means Elijah has no sweat glands. Although AED is a terrible condition, Elijah was able to obtain necessary medical care when he had Medi-Cal. But Elijah’s Medi-Cal coverage was cut off without any warning in the Spring of 2010 as he supposedly had other health coverage through a Blue Cross HMO. I am submitting this declaration because Elijah was unable to receive medical care he badly needed for about six months until we finally got his Medi-Cal coverage restored. It is no exaggeration to say that this almost cost him his life. 2. I was born in California and have lived worked in the state for many years. My father retired from the military in California. I am the single mother of three children. Besides Elijah, I have two girls, Joy, age 12, and Trinity, age four. 3. Elijah has been receiving Supplemental Security Income (SSI) due to his disability ever since age three. 4. Allkinds of terrible things happen to Elijah’s body because he lacks sweat glands. He has suffered ever since he was born and spent much of his life as a baby and toddler going in and out of hospitals. 5. For example, because of the AED, Elijah’s T-cells are different from normal ones, and this makes him very vulnerable to infection. Cuts, scrapes, openings in the skin of any kind can be very dangerous to him, they make him susceptible to staph infections. He gets ear and other kinds of infections a lot. He frequently has to take antibiotics to DECLARATION OF CRISTINA JONES ISO MOTION FOR WRIT OF MANDATE CPF 09-509847Cm ND HW BF WN NP N YN NN WY |= ee Be Be Be Be Be ee IDA WF YB KH = SCH ADA BF BH = DO » % prevent or control infections. He has become resistant to some antibiotics and has been hospitalized several times for staph infections. 6. Elijah’s teeth don’t grow in, or grow slowly and poorly, because of the AED. He’s 9 years old now but only has seven teeth, and these are malformed. He needs gum reconstruction so that dentures can eventually be fit for him. In the meantime, Elijah’s oral health condition creates difficulty with his speech, and it makes eating many kinds of food difficult if not impossible. Elijah’s diet consists only of soft foods, and I and his doctors have to keep watch on his nutrition and whether he’s gaining enough weight for his age. 7. Elijah gets nose bleeds a lot, his throat is sore and raspy most of the time, and he is at risk for serious eye problems, like glaucoma, because of the AED. 8. The AED also makes his nails and skin very thin. He breaks out in severe eczema easily if it is not controlled with medication. The eczema makes his skin very sensitive, flakey and itchy, it gets red and inflamed, the skin rises up and gets infected easily. To control the eczema, we have been applying topical steroid creams to his skin, ever since he was a baby. These creams require a prescription. These drugs can, however, cause cancer, so he has to be monitored regularly by a doctor to see if any bad side effects are developing from the treatment to control his eczema. 9. Elijah was diagnosed with attention deficit hyperactivity disorder (ADHD) several years ago. He takes a prescription medication for his ADHD, called Adderall. Late last year, he was also diagnosed with mood disorder and explosive personality. Elijah needs weekly individual therapy sessions with a psychiatrist, he started weekly therapy with a psychiatrist when he was about eight years old. DECLARATION OF CRISTINA JONES ISO MOTION FOR WRIT OF MANDATE CPF 09-509847Coe ND HW FB WN 10. I met the father of my three children in high school. We separated in 2007 and have not communicated at all in the past four years. He was extremely emotionally abusive to me, I was terrorized with death threats and in other ways. Although we were never married, I did get support orders for each of the kids we separated; my parents insisted that I get a court order when my first child, Joy, was born. I later asked the court to add Elijah and then Trinity to the court order after their births. My whereabouts are not disclosed in the orders so that my ex cannot come after me. As it turns out, I haven’t collected much in child support from the kids’ father over the years, in many years none at all, and I don’t know where their father is now. 11. I attended Laney College in Oakland for one year. I received my Bachelor of Science degree in Psychology from Texas Wesleyan University in 2008. My mother lives in Oakland now. I have been moving back and forth between California and Texas most of my life. My dad was from Texas, and a lot of our family is still in Texas. Dad came to California with the Army; he retired from the Army in about 1989. My brother just retired from the Army in 2010. I guess you could say we are an Army family. Dad was one of Elijah’s primary caregivers for many years, until he died in 2007. Dad’s passing was a huge blow to both Elijah and me. 12. From about 2008 to about the end of 2010, we lived in Alameda County, first in Hayward, then Oakland, and finally Concord. I was in school full time, working on getting my Masters Degree in Marriage and Family Therapy at JFK University in Pleasant Hill. I also had a full time job as a mental health counselor at the Seneca residential facility in Concord. Seneca serves severely emotionally disturbed youth and DECLARATION OF CRISTINA JONES ISO MOTION FOR WRIT OF MANDATE CPF 09-509847an vp wi N other youth with serious mental health conditions. As my job didn’t pay much, Elijah continued to qualify for SSI. 13. Elijah and my two daughters also qualified for Medi-Cal. With his Medi-Cal, Elijah was regularly seen at a clinic in Piedmont that is part of Oakland Children’s Hospital. I would drive all the way over from Concord because it is so hard to find a doctor who knows about Elijah’s condition, which is pretty rare. Elijah had a primary care doctor at this clinic, Dr. Pamela Sims-Mackey, who monitored his AED and symptoms, prescribed Elijah’s topical skin creams and checked up on their impacts, provided normal childhood care, like immunizations, and prescribed and monitored his ADHD medications. I also took Elijah to this clinic when he got sick. When it was an emergency, I would take him to the Emergency Room at Oakland Children’s Hospital. 14. Dr. Sims-Mackey also arranged for Elijah to be seen with Medi-Cal by a panel of genetics specialists at UCSF Children’s Hospital in San Francisco. | think it was around spring time in 2010 that I took Elijah there. He was seen by an opthamologist, an ear, nose and throat specialist, a speech pathologist, and an cranial-facial surgeon. After this visit, which took most of the day, a referral was made for further consultation with a cranial-facial surgeon so that Elijah could eventually get have his gums reconstructed and get dentures. 15. Before spring of 2010, we had no problems with Elijah’s Medi-Cal coverage. But then one day sometime after his visit with the specialists at UCSF, when I took him to the Piedmont clinic for a medical appointment, they told me they could not use Elijah’s Medi-Cal anymore because his Medi-Cal file showed he had other coverage. They didn’t DECLARATION OF CRISTINA JONES ISO MOTION FOR WRIT OF MANDATE CPF 09-509847oO YN DH RB WHY BOGOR = 6s 15 tell me what the other coverage was. I was shocked. Elijah didn’t have any coverage other than Medi-Cal, he’s never had any other coverage, other than Medicaid in Texas. 16. The same thing happened when I went to the clinic’s pharmacy that same day to try fill the prescription for Elijah’s medications. The pharmacy said Medi-Cal wouldn’t cover Elijah anymore, that his file showed he had other coverage. 17. It also happened when I took Elijah to his next weekly individual therapy with his psychiatrist. They said his Medi-Cal file said he had other coverage and they couldn’t see him anymore as a Medi-Cal patient. They said they would give him two more therapy sessions for free, but that was it. This was a huge blow to Elijah because he had become very close to this psychiatrist. 18. I never received anything in writing from Medi-Cal or anyone else saying that Elijah supposedly had other coverage. Nobody told me who the other coverage was, nobody gave me a policy number for the other coverage Elijah supposedly had or told me where to go to get him medical care with his other coverage. I had no way to contact my ex to see if he knew what this might be about. And I never got anything from Medi-Cal saying how I could appeal or get the other coverage off Elijah’s Medi-Cal file. 19. I tried for months to figure out how to get Elijah’s Medi-Cal back. I contacted a social worker at Oakland Children’s Hospital. She contacted the Medi-Cal program and told me that Elijah’s other coverage was supposedly a Blue Cross HMO. She said the only way I could get this off Elijah’s Medi-Cal file was to prove he did not have Blue Cross. I asked for but received no further help from her. The same thing happened when I contacted Elijah’s eligibility worker at Alameda County. She just told me I needed to DECLARATION OF CRISTINA JONES ISO MOTION FOR WRIT OF MANDATE CPF 09-509847oC Om YN DH BB wWN ® e get proof in writing that Elijah didn’t have other coverage, she said he would have to use Blue Cross until then. 20. I found a phone number for Blue Cross on my own. I asked if they could give me a print out or just anything else in writing to show that my son did not have a Blue Cross policy. They wouldn’t give me anything in writing, and they said they couldn’t issue a start or end date of coverage because I had no policy number. Of course, I had no policy number because Elijah had never been covered by Blue Cross. Blue Cross did say that they would be willing to talk with anyone from Medi-Cal who called them, but that was no help to me because the two social workers I talked with said the proof had to be in writing. 21. A little while after this, Elijah got a bad ear infection, so I took him to the Emergency Room at Oakland Children’s Hospital. They saw him for free there and gave him some antibiotics. 22. But there was so much more medical care he needed that we couldn’t get for him during a period of about six months in 2010 when the Blue Cross HMO was in his Medi- Cal file and I didn’t know what more to do to try to get it off. I didn’t follow up with the cranial-facial surgeon for the additional consultation recommended by the geneticists panel at UCSF Children’ Hospital for the gum reconstruction Elijah needed, so he could get dentures. I knew I couldn’t use Medi-Cal and I had no way to pay for such expensive services. 23. There was no way I could afford to buy Elijah’s medications. The steroid skim creams alone that Elijah needs cost hundreds of dollars a tube. Without his prescription creams, Elijah broke out in horrible eczema and was in extreme pain and discomfort. He 6 DECLARATION OF CRISTINA JONES ISO MOTION FOR WRIT OF MANDATE CPF 09-509847Cem ND WH F Ye YH YP RR R YR NR NY KY KY & Bee Be ewe we Be ewe eB kn yxy YD DHA FF OB YH = SC wH AY DAA BRB HH | S hurt and itched all over, he couldn’t sleep, he was agitated. I was deathly afraid he’d get another staph infection and have to be hospitalized. He still has scars all over his body from that time in 2010 when I couldn’t afford to buy his medications and Medi-Cal would not cover them because his file said he had other coverage. 24. I couldn’t afford his ADHD medications, either; they also cost much more than I could pay, around $ 200 for a month worth of pills for him. Off his meds, not able to see his psychiatrist anymore, and suffering horribly from eczema, Elijah went completely downhill emotionally and mentally. He became very aggressive and disruptive, throwing major tantrums frequently. His behavior was out of control, both at home and at school. 25. Things got so bad that I had to quit my Masters program and also my counselor’s job at Seneca to take care of my son full time. 26. In October 2010, I took my daughter Trinity to the Piedmont clinic. There was no problem with her Medi-Cal, and she was seen that day by the doctor. My daughter had the same primary care doctor as Elijah had, Dr. Sims-Mackey. The doctor asked me how Elijah was doing and why I hadn’t brought him in for a medical visit in so long. When I told her about Elijah’s deteriorating condition and that I had to stop taking him to see her because of the problem with the private Blue Cross HMO showing up in his Medi-Cal file, she referred me to the East Bay Community Law Clinic (EBCLC) in Berkeley. 27. EBCLC helped me get the Blue Cross HMO off Elijah’s Medi-Cal, I think it was sometime shortly after I spoke with Dr. Sims-Mackey in October 2010. But by then, I had decided to move back to Texas and was getting my children’s Medicaid and Elijah’s SSI transferred there. I had lost hope that things could ever get fixed with his Medi-Cal, 7 DECLARATION OF CRISTINA JONES ISO MOTION FOR WRIT OF MANDATE CPF 09-509847and I was worried that even if there was a fix, the Blue Cross might pop up in his Medi- Cal file again. I had never had a problem using Elijah’s Medicaid card in Texas. 28. I was able, thankfully, to use Elijah’s Medi-Cal again before we left for Texas. I got his skin creams right away, and his ADHD medication. I probably also took him in to see the doctor. 29. But it took a long time to get him stabilized. It takes time to readjust to the ADHD medications and for them to build up in his system the right way. He continued to have major problems even after we moved back to Texas in December of 2010, to the point that he started physically hurting himself. It was so horrible to watch my son deteriorate to that point. I had to have my son admitted to an in-patient psychiatric hospital to protect himself. This happened in February 2012. The hospital is called Millwood Hospital; it is located in Arlington, Texas. 30. My children and I now live in Fort Worth, and I am back in a Masters program in Marriage and Family Therapy at Texas Wesleyan University. I’m also working full time again as a counselor for severely emotionally disturbed youth. My employer is a private company that has a contract to provide mental health services to at risk youth for Tarrant County through the Texas Medicaid program. 31. The Blue Cross HMO has never come up on Elijah’s Medicaid file in Texas. 32. It has taken about a year to get Elijah’s medical and mental health situation under control. With his Texas Medicaid, he is back in weekly mental health therapy sessions with a psychiatrist, I am able to fill his prescription medications, he has a primary care doctor again who monitors his condition, and we are on track to get his gum reconstruction and then dentures. DECLARATION OF CRISTINA JONES ISO MOTION FOR WRIT OF MANDATE CPF 09-509847Co Oo YD DH BF WHY - co 12 33. Even though I live in Texas now, I hope that no other child or person with Medi- Cal to ever has to go through what my son suffered when he lost access to his Medi-Cal coverage. It was so painful for Elijah and our family. I have a college education and I’ ve been working in the mental health field with families whose coverage is through Medicaid; I can only imagine how much harder it must be for families who don’t have my experience and background to try to figure out what to do when the state claims a person with Medi-Cal also has some other private insurance that they don’t actually have and that they can’t use. 1 1 W 4 i H 1 MH HW HW M DECLARATION OF CRISTINA JONES ISO MOTION FOR WRIT OF MANDATE CPF 09-509847co Oo YN DW BF WwW NY A aE BHR AS ye Se SC Oo em NK I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed on Yl 20012, in Forth Worth, Texas. CRISTINA J Ss 10 DECLARATION OF CRISTINA JONES ISO MOTION FOR WRIT OF MANDATE CPF 09-509847Com IN DH & DECLARATION OF MARIA MARQUEZ I, Maria Marquez, hereby declare that I have personal knowledge of the following facts and that, if called as a witness, I could and would competently testify thereto: 1. I live in San Francisco, California, with my son, J. O., who was born in 2001. He is 11 years old. 2. J.O.’s father and I separated around 2005 because of severe domestic violence. The doctors and counselors who have seen my son since the separation have told me that he needs individual therapy to help him deal with the domestic violence that went on before the separation. 3. Soon after his father and I separated, J.O was evaluated for whether he needed mental health services. This was done at San Francisco General Hospital (SFGH), they have a program there that helps children who have witnessed severe violence. After a while, he saw a therapist named Erica Torres. I don’t remember exactly when this was, but it was a few years ago. 4. After a while, Erica Torres told me that she was leaving the SFGH and she referred me to an agency called Access to get a referral for Medi-Cal to pay for a therapist for J.O. 5. Icalled the Access telephone number and they arranged for J.O. to see a therapist named Norma Aguilar for individual therapy once a week. 6. J.O. saw Ms. Aguilar for individual therapy sessions about two times. She also came to J.O.’s school about two times to observe him. 7. After about two individual sessions at her office, Ms. Aguilar told me that J.O. DECLARATION OF MARIA MARQUEZ ISO MOTION FOR WRIT OF MANDATE CPF 09-509847Dn FB ww would have to stop coming to see her because Medi-Cal would not pay for the therapy sessions since we had Kaiser health insurance. Soon after that I got a telephone call from aman who said he was from Access. He also told me that J.O. would have to go to Kaiser for his therapy. The Kaiser health insurance is from his father’s employment. 8. I did not receive any written notice from Medi-Cal or Access or anyone else that Medi-Cal would stop paying for his therapy because J.O. had Kaiser health insurance. My son did not receive any written notice like that, either. We were never told that we had the right to challenge the decision to stop Medi-Cal paying for J.0.’s individual therapy. 9. 1 tried taking J.O. to Kaiser for his mental health therapy but it did not work. First. Kaiser did not offer J.O individual therapy, which is what he had been getting at SFGH and through Medi-Cal from Ms. Aguilar. Instead, Kaiser offered him some family therapy and group sessions with other children. 10. Also, the Kaiser building where the mental health services were provided was far away from our home. It always took about 70-90 minutes to get there. The round trip was often three hours. We had to travel by San Francisco MUNI bus, and the trip took three different buses to get there and three to get back home. Because of the amount of time it took to get to the Kaiser building, J.O. had to leave school early, which was causing problems. J.O.’s father took him sometimes but not always. Whenever I took him, we had to travel by bus. 11. Kaiser also charged for each visit and prescription medication. Medi-Cal has not charged for these. At first I tried to pay the Kaiser charges but eventually I could not afford them. DECLARATION OF MARIA MARQUEZ ISO MOTION FOR WRIT OF MANDATE CPF 09-509847wn 12. After a few visits, a Kaiser doctor prescribed a medication to help my son sit still and pay attention. The first time I filled the prescription, Kaiser charged me about $150. I paid with my credit card. The second time, Kaiser charged me about $85. I could not afford these charges so I stopped getting the prescriptions filled. 13. Kaiser also charges for services other than prescription medications. The co-payments for the family counseling and group counseling were about $20 per session. 14. Because of the problems getting to the Kaiser mental health services, the fact that there was no individual therapy, and the costs, I stopped taking J.O. to Kaiser for mental health services. 15. During this time, J.O. seemed to get worse. He had problems concentrating and remembering things. He had a hard time doing his homework and was easily frustrated. His teachers called me during this time and said it was hard to keep him focused and he would not sit still. He wet his pants because a teacher thought he was just fidgeting when really he had to go to the bathroom. 16. Also, during this time, Bay Area Legal Aid was helping me in Family Court. When I told them about the problems I was having getting J.O.’s mental health services and medications, they helped here too. They helped me get Medi-Cal to start covering his individual therapy and medications again. 17. J.O. is still in weekly individual therapy at the Mission Family Center in San Francisco. He still takes medication to help him sit still and pay attention in school so he can learn and not fall behind. Medi-Cal is covering the therapy and medicines so I do not have to worry about charges for mental health services and medications that I DECLARATION OF MARIA MARQUEZ ISO MOTION FOR WRIT OF MANDATE CPF 09-509847cannot afford. The Center is closer to our home and J.O.’s school, so it does not take so long to get there and he does not have to skip school to get there on time. 18. J.O. continues to suffer from attention problems and anxiety, but he has been doing much better in school and at home since we got his Medi-Cal back and he is getting his weekly individual mental health therapy again and his medication. The medication has side effects. My son loses his appetite and eats very little when he takes his medication. He also has trouble sleeping when he takes the medication. Because of the side effects, the doctor gave me the option not to give my son his medication when he is not in school. To give J.O. relief from the side effects, I do not give J.O. his medications on weekends or during school holidays and school breaks. 19. I could not have managed on my own to get my son’s Medi-Cal back for his individual health therapy and medication without Bay Area Legal Aid’s help. I don’t want any other family to have to go through what I went through with J.0.’s Medi-Cal being blocked and not being able to get the therapy and medication that J.O. needed. It is terrible as a mother to watch your child suffer and not know how to help him feel better. 20. This declaration was translated to me in Spanish by Maria Frias at Bay Area Legal Aid. i! i if / i i DECLARATION OF MARIA MARQUEZ ISO MOTION FOR WRIT OF MANDATE CPF 09-509847I declare under penalty of perjury that the foregoing is true and correct. Executed on lo 7 t-2OQ in San Francisco County, Ca lifornia Le Maria Marquez DECLARATION OF MARIA MARQUEZ ISO MOTION FOR WRIT OF MANDATE CPF 09-509847kuhPov snarion OF VIRGINIA oo I, Virginia Ochoa, hereby declare that, if called as a witness, I could and would testify to the following: 1. 1 live in Littlerock, California. Maricella Rivera is my granddaughter. In 2009, Maricella and her brother, Mario Rivera, were living with me, their legal guardian. They both had Medi-Cal and also Kaiser, through their father. 2. In August of 2009, Maricella’s prescription glasses were broken. She was cighteen years old at the time. I couldn’t afford to buy her another pair. I tried to get her another pair of glasses with her Kaiser and her Medi-Cal but neither one of those would work. It took about three months before Maricella got new glasses through Medi-Cal, and it was only with help from the Health Consumer Center in Pacoima that this happened. Because Maricella’s eyesight is so bad, she had a real hard time in school and pretty much everywhere else during those three months without proper eyeglasses. 3. After Maricella’s glasses were broken, I took her to Kaiser in Lancaster to try to get her new eyeglasses, but Kaiser said Maricella’s plan didn’t include eyeglasses. Actually, [ wasn’t surprised, because Mario’s glasses had broken a few months before and Kaiser wouldn’t cover his glasses. | had to pay for them on my own; it was really expensive. 4. I couldn’t afford to buy glasses for Maricella, so I took her to a Medi-Cal optometrist to try to get her a pair of glasses with her Medi-Cal card. But the optometrist said I had to take Maricella to Kaiser for the glasses because her Medi-Cal file showed she supposedly had Kaiser for everything. 5. So then I tried another Medi-Cal optometrist. The same thing happened there: Maricella’s Medi-Cal was not accepted because her Medi-Cal file said she had Kaiser for everything. 6. After that, | contacted the Health Consumer Center at Neighborhood Legal Services in Pacoima. They had helped me before when Maricella had a problem using Medi-Cal for dental services, so I thought I would try them again. The Health Consumer DECLARATION OF VIRGINIA OCHOA ISO MOTION FOR WRIT OF MANDATE CPF 09-509847oe NY DH nH BF BW N NN NY NY NY N NN DY HB Se Bee Be eB Be ewe ee oN A A FF YWw DH |= SGC wMe RAH BF wWwNH KF SO Pcusration OF VIRGINIA oc Center helped me get the glasses for Maricella with Medi-Cal. But that didn’t happen until late October, almost three months after her glasses got broken in August. 7. When Maricella was turned away from Medi-Cal for glasses, we didn’t get any notice in writing telling us what to do to be able to use her Medi-Cal for glasses if Kaiser didn’t cover glasses for her. 8. Without the Health Consumer Center, I don’t think I would ever have been able to figure out how to get new glasses with Medi-Cal for Maricella. I had been trying on my own, going back and forth between Medi-Cal optometrists and contacting Kaiser, but that didn’t work. I don’t want other families to have the same problems, not for any of their medical care. 9. Maricella’s eyesight is very poor. The taped up glasses she had to wear for about three months until we could get her new glasses through Medi-Cal didn’t fit her right, they were all crooked. Also, one of the lenses was chewed up by a dog. So she hada terrible time trying to read and pay attention at school and she got a lot of headaches until her glasses got fixed. She also said she felt embarrassed wearing the taped up glasses, especially around other kids. I declare under penalty of perjury that the foregoing is true and correct. Executed on s J. 20 , 2012, in Los Angeles County, California. \Ga ma Oc fora rginia Ochoa 2 DECLARATION OF VIRGINIA OCHOA ISO MOTION FOR WRIT OF MANDATE CPF 09-509847pM aration OF MARICELLA iv I, Maricella Rivera, hereby declare that, if called as a witness, I could and would testify to the following: 1. I live in Littlerock, California. I am 21 years old now. In 2009, I was 18 and living with my grandmother who had taken care of me for several years. 2. In August of 2009, my glasses were broken. I was staying the night at my aunt’s house. While I was sleeping, her dog grabbed my glasses off a coffee table and chewed them up, damaging one of the lenses and the frames. So I got a pair of old sunglasses, took out the dark plastic lenses, and taped in my prescription lenses, it looked very weird. I was very self-conscious about how my glasses looked, especially when | was in public or around other teenagers, like when I started back at school. It was embarrassing, I had enough problems being a foster kid; looking weird was another blow to my self-esteem, to my feelings that my parents didn’t want me, it added to my insecurity. It may not seem like a big deal to an adult, but to me it was very upsetting and affected my moods, my ability to concentrate or socialize with other people. 3. Plus, these makeshift glasses didn’t sit right on my face and felt like the sides were cutting into my face. I couldn’t see out of the lenses very well especially the lens that got chewed up. I kept having to try to place the lenses right, which I never managed to do, so I got headaches with the glasses on or off and I couldn’t see very well. I have worn glasses for as long as I can remember, ever since I was a little kid. My eyesight is really bad. I need glasses for everything, for seeing far away, for reading, looking at the blackboard when I was in school, for doing just about anything. I sometimes bump into things when I don’t have glasses on, my eyesight is that bad. 4, I had Medi-Cal at the time my glasses broke. I also had a Kaiser card from my father’s insurance. My grandmother tried to get me new glasses with my Medi-Cal but the Medi-Cal wouldn’t work because of the Kaiser. So I went without proper glasses for about three months, until October, when the Health Consumer Center helped me be able to use my Medi-Cal again. I DECLARATION OF MARICELLA RIVERA ISO MOTION FOR WRIT OF MANDATE CPF 09-5098471M aranion OF MARICELLA Pea 1/5. If I didn’t have an advocate at the Health Consumer Center, I don’t think my 2 || grandmother and I would ever have been able to figure out how to get my new glasses 3 || with Medi-Cal. I don’t want other kids to have the same problems, not for any of their 4 || medical care. 5 6 I declare under penalty of perjury that the foregoing is true and correct. Executed “th 7 {jon May xD > 2012, in Los Angeles County, California. . 8 9 Maricella Rivera 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 2 DECLARATION OF MARICELLA RIVERA ISO MOTION FOR WRIT OF MANDATE CPF 09-509847Fw oN DECLARATION OF ANA VALENZUELA I, ANA VALENZUELA, hereby declare that, if called as a witness, I could and would testify to the following: 1. I work for a non-profit organization in Los Angeles, called Maternal and Child Health Access (MCH Access). I have worked as an outreach worker for MCH Access for about 14 years. I help low-income families in Los Angeles County enroll in Medi-Cal and other health programs, and I also help them fix problems that come up so that they can get access to medical care with their Medi-Cal. I handle an average of about 35 cases a month. 2. Many of my cases involve women and children who cannot access Medi-Cal services because their Medi-Cal files are linked mistakenly to Other Health Coverage (OHC) that the clients do not have. I get at least one new case of this type a week, and many weeks, I get two or three such cases. When a person’s Medi-Cal file is marked with OHC, delays in getting Medi-Cal services can happen. Such delays can be very dangerous, depending on the client’s health circumstances; even a short delay of a few days can be very harmful. Two recent examples are described below. These examples are, unfortunately, not unique. 3. On January 23, 2012, I was contacted by a pregnant woman who said she was going to have her baby in about two weeks and needed help getting to use her Medi-Cal for prenatal care and for the hospital to deliver the baby. She said she had recently gone to South Bay Community Family Health Care in Torrance, California for prenatal care, but they would not see her with Medi-Cal because OHC showed up in her Medi-Cal file. South Bay referred the woman to MCH Access for help getting the OHC removed. DECLARATION OF ANA VALENZUELA ISO MOTION FOR WRIT OF MANDATE CPF 09-5098474. I checked the woman’s file on-line in AEVS, which is Medi-Cal’s Automatic Eligibility Verification System; community organizations, like MCH Access, can get state approval to access the AEVS system. The AEVS report (Exhibit A to my declaration) said the client had OHC. But the client said she didn’t have OHC of any kind. She also said that before she went to South Bay no one had told her that she supposedly had OHC. She had no idea why anyone would think she had OHC. I called the clinic; they confirmed they would not see her because of the OHC. 5. Usually, when I have a client who is having a problem using her Medi-Cal because her file says she has OHC when she doesn’t have OHC, | start by sending the state an e-mail, asking that the OHC be removed. But it often takes several days or even several weeks or more before I get a response from the state to these e-mails. 6. So in this case, because the client was so close to having her baby and couldn’t get any prenatal care through Medi-Cal, instead of e-mailing I telephoned the State Department of Health Care Services (DHCS) in Sacramento to ask that the client’s OHC be removed on an urgent basis. I made this call the same day the client contacted me, January 23, 2012. The person I spoke with identified himself as James Riley. He said he would remove the OHC. The next day, January 24, the client’s file showed OHC was removed (see Exh. B), and the client was able to be seen with Medi-Cal at South Bay for prenatal care. 7. On February 24, 2012, the client contacted me again. Her baby had been born by C-section. When she went to South Bay on February 17, 2012 for her scheduled post- partum appointment to have the staples removed, the clinic would not see her because the same OHC had returned to her Medi-Cal file. On the same day the client contacted me, DECLARATION OF ANA VALENZUELA ISO MOTION FOR WRIT OF MANDATE CPF 09-509847PB wWoN February 24, 2012, I sent an e-mail message to State DHCS, marked “Urgent”, to ask that the OHC be removed again. 8. The client called me again the afternoon of February 29, 2012. I checked AEVS, and the client’s Medi-Cal record still showed the OHC (see Exh. C). By then, the client was in terrible pain and discomfort, I could tell by how she sounded over the phone. She said she was taking painkillers and also that she was very worried that she was getting an infection from the staples. I discussed the case with my supervisor at MCH Access, Celia Valdez. I understand that Celia contacted Lucy Quacinella. 9. The next morning, March 1, 2012, Lucy informed me that DHCS said it had taken care of the client’s OHC code problem, but that the change would not show up in the client’s Medi-Cal file until the following day, March 2. I contacted the provider, South Bay, the morning of March 1, 2012 and explained that the OHC was being removed. | asked the provider to see the client that same day, March 1, because she seemed to be in such bad shape. But they said no, she would have to wait until 8:30 a.m. the following day, that she could not be seen as a Medi-Cal patient until her Medi-Cal file showed the OHC was removed. So I made an appointment for the client for 8:30 a.m. March 2, 2012. 10. When I spoke with the client again on March 1, 2012, around noon, she said she was in so much pain that her husband had helped her pull out two of the staples by hand. She explained to me that they were very worried about infection because of the pain and because she had chills and the skin around the staples was swollen and red. She said there were about 12 more staples left. I discussed the case again with Celia, and - then contacted the client to recommend that she stop pulling out the staples herself and DECLARATION OF ANA VALENZUELA ISO MOTION FOR WRIT OF MANDATE CPF 09-509847instead go directly to the hospital emergency room right away. Her condition sounded too risky to wait for medical care any longer. She might get a big medical bill from the emergency room, but we could try to help her address that later. 11. The client called me the next day, March 2, 2012, to let me know she had decided not to go to the hospital the day before. Instead, she waited and went to her medical appointment at South Bay the morning of March 2. She said that the doctor told her the area around the staples had in fact become infected. She said she was given antibiotics to treat the infection. A follow up appointment was scheduled for March 29, 2012. 12. Unfortunately, that was not the end of this poor client’s troubles with OHC and Medi-Cal. On Thursday, March 22, 2012, the client called MCH Access and left a message for me to call her back. I was out of the office March 22 and 23. On Monday, March 26, 2012, I returned the client’s call. She said that South Bay had contacted her to report that the OHC had showed up in her Medi-Cal file yet again (see Exh. D) and that the clinic would not see her on March 29, 2012 unless the OHC was removed by then. . 13. Since the time was so short until the client’s next appointment, I called the DHCS office in Sacramento on March 26, 2012 instead of sending an e-mail. | left a message in voice mail for James Riley. I did not get a call back, so on March 29, 2012 I left another voice mail message for Mr. Riley. 14. I did not receive a return phone call from Mr. Riley or anyone else at state DHCS. Because OHC was still in the client’s Medi-Cal file, South Bay would not see her on March 29 and instead re-scheduled her for April 2, 2012. But OHC was still in the client’s Medi-Cal file on April 2(see Exh. E), and so South Bay still would not see her. 15. On April 3, 2012 I placed a phone call to Robert Bonkowski at DHCS, asking that 4 DECLARATION OF ANA VALENZUELA ISO MOTION FOR WRIT OF MANDATE CPF 09-509847fw oN the client’s OHC be removed. He said he would take care of it. I checked the client’s AEVS file on the following day, April 4, 2012, and I saw that OHC had been removed. With the OHC removed, the client was seen by South Bay on April 9, 2012. I did not keep a copy of the AEVS record that I accessed on April 4, 2012 showing OHC was no longer in the client’s Medi-Cal record. 16. But when I checked AEVS on April 12, 2012, OHC had been reinstated yet again (see Exh. F). Even after so many phone calls to the state and even a personal call with Mr. Bonkowski, the OHC keeps returning to this woman’s Medi-Cal file, and I don’t know what more I myself can try to do to get it permanently removed for her. In October 2012, the client asked me if the OHC had been removed yet. I checked AEVS for her, she still had OHC on her Medi-Cal file. 1 used the state’s on-line system to make yet another OHC removal request for her, on October 10, 2012. It took about two weeks before the OHC was removed; given the history here | believe it is only a question of time before the OHC goes back on this client’s file. 17. Another recent case also shows the health access barriers that Medi-Cal beneficiaries may face when OHC is on their Medi-Cal but they don’t have OHC. On April 23, 2012, 1 was contacted by a pregnant woman whose estimated delivery date was May 5. She said she had been receiving prenatal care at Clinica San Miguel but had just been told that the clinic could no longer see her because her Medi-Cal file was showing OHC with Kaiser. I ran an AEVS report for her (Exh. G). The woman said she did not have any OHC, had no idea why the state would think she had Kaiser. The woman seemed panicked, very stressed out because she did not want to show up at the hospital uninsured when she went into labor. DECLARATION OF ANA VALENZUELA ISO MOTION FOR WRIT OF MANDATE CPF 09-50984718. That same day, April 23, 2012, I sent DHCS an e-mail marked urgent, requesting that OHC be removed from her file. The OHC was still there the next day, April 24, 2012, so, since this case was so time sensitive, I called Mr. Bonkowski in Sacramento; he said the OHC would be removed, effective the next day. I was out sick April 25. On April 26, 2012, I checked AEVS, and the OHC was gone from this client’s Medi-Cal record (see Exh. H). | also spoke with the client that day—and learned that her baby had already been born, i.e., before the May 5 estimated due date. If MCHA hadn’t spoken with Mr. Bonkowski directly, this woman would have been uninsured when she arrived at the hospital to deliver her baby, which is exactly what she had been trying to avoid. I am happy we had the expertise and the contacts to help her—but most low-income women in need do not have an advocate. i HW i i MH // Il // // MI i DECLARATION OF ANA VALENZUELA ISO MOTION FOR WRIT OF MANDATE CPF 09-509847I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed on mH 2012, in Los Angeles County, California. DECLARATION OF ANA VALENZUELA ISO MOTION FOR WRIT OF MANDATE CPF 09-509847 ANA VALENZUELAMedi-Cal: Eligibility Response Ey . f \ Page 1 of 1 Department of Health Care services QD Meds Cal Home -» Transaction Services Eligibility Response igibility transaction performed by provider: 13CHILDAG —_> on Monday, January 23, 2012 at 4:08:52 PM ‘\ a a , “ene ap Seca? =_—— Service Date: 7 Subscriber Birth Date: Issue Date: 01/09/2012 11/07/1976 11/19/2007 Primary Aid Code: First Special Aid Code: 3N Second Special Aid Code: Third Special Aid Code: Subscriber County: HIC Number: 19 - Los Angeles Primary Care Physician Phone #: Service Type: 3234637262 Vv Trace Number (Eligibility Verification Confirmation (EVC) Number): 691H9P3P4Z Eligibility Message: SUBSCRIBER LAST NAME: EP eve #: 691H9P3P4Z. CNTY CODE: 19. PRMY AID CODE: 3N. MEDI-CAL ELIGIBLE Wi NO SOC/SPEND DOWN. HEALTH PLAN MEMBER: PHP-HLTH NET: MEDICAL CALL (800)675-6110, HCP: CALL (800) 875-6110 FOR HCP INFORMATION. PCP: BENJAMIN BEHROQZAN CALL: (323)463-7262. HEALTH NET OF CALIF A, INC: DENTAL IR CODE V. CARRIER NAME: - v UNITED HEALTHCARE. COV: V. Conditions of Use | Privacy Policy Copyright © 2007 State of California Server:sysdev.medi-cal.ca.gov |File:/Etigibility/EligResp.asp |Last Modified: 10/24/2008 10:52:14 PM. y CALL (800)977-7307. Medi-Cal: Eligibility Response h » 13 Page | of 1 Bepartment of Health Care services QD Mec Cal Home -» Transaction Services ligibility transaction performed by provider: t HILDAC on Tuesday, January 24, 2012 at 10:06:17 AM. Subscriber ID: = Service Date: Subscriber Birth Date: Issue Date: 01/01/2012 14/07/1876 41/19/2007 Primary Aid Code: First Special Aid Code: 3N Second Special Aid Code: Third Special Aid Code: Subscriber County: HIC Number: 19 - Los Angeles Trace Number (Eligibility Verification Confirmation (EVC) Number): 1319NSGWGJ Eligibility Message: SUBSCRIBER LAST NAME: QQ? EVC #: 131SNSGWGJ. CNTY CODE: 19. PRMY AID CODE: 3N, MEDI-CAL ELIGIBLE W/ NO SOC/SPEND DOWN. HEALTH PLAN MEMBER: PHP-HLTH NET: MEDICAL CALL (800)675-6110. HCP: CALL (800) 675-6110 FOR HCP INFORMATION. PCP: BENJAMIN BEHROOZAN CALL: (323)463-7262. HEALTH NET OF CALIFORNIA, INC: DENTAL Conditions of Use | Privacy Policy Copyright © 2007 State of California Server:sysdev.medi-cal.ca.gov |File:/Eligibility/EligResp.asp |Last Modified: 10/24/2008 10:52:14 PM Exh. Bi Edit. View Favorites. Tools. “Help Gog p Favorites: 1 & (elSuagested Stes © B) Med See Galley + B Bing? Tlfic ZFree Hotmail NG (DHS Money 5} SN SideShow + GQ MIN: MONEE (Q My MSN Gr Br Br Poe Seyr Toohey Gr [Bw |e er L Aitotity Morey GTR Signin —ry |B chiens Heath Cue (@ Wed Cab igityRes. x | E16 Ger Heth Oar} a | 'RANSACTIONS + Elgity -» Single Subsciber > Maliple Subscribers » PIN > Batch internet Eighty » MediSenices SOC (Spend Down) = Chins | “Batch Cem Stats - > eTAR Medical PeTARPharmacy a aa Conditions of Use| Privacy Policy Copyright© 2007 Stat of Calcia Serersyte etic gy Fir iosp ap Lo yg 03Medi-Cal: Eligibility Response Beh . 6 Page 1 of 1 Depa nt of Health Care services QD Mede—Gal Home -® Transaction Services igibility transaction performed by provider: 13CHILDAC in Monday, March 26, 2012 at 2:20:33 PM ) —— Name: Subscriber ID: 2 Service Date: Subscriber Birth Date: Issue Date: 03/01/2012 11/07/1976 11/19/2007 Primary Aid Code: First Special Aid Code: 3N Second Special Aid Code: