Knowledge is Power: Consumers Deserve to Know Their Rights to Timely Access to Care & Language Assistance

For three years, I worked at a free community clinic that catered to East and Southeast Asian patients. The pace was fast: 30-40 patients were seen per day. Why the high numbers? When asked what drove them to the clinic, the most common response from patients was that they lacked the ability to see their assigned health care provider when needed, and even if they could get an appointment, as non-English speakers they wouldn’t be able to communicate with them anyways. Without timely access and language assistance, these patients turned to safety net clinics to receive the care, often travelling for hours on public transportation to see a doctor. At the clinic, patients received same day service and were given the translation options.

These anecdotes are reflected in the data. A secret shopper survey in 2015 found that, on average, newly insured (under Covered California and Medi-Cal) patients seeking primary care were able to secure an appointment abiding to timely access regulations less than 30% of the time.[1]

These barriers to health care added to the already high stress that comes with needing medical care. Many of the patients also have Medi-Cal, proving that just because someone has insurance does not mean they have access to care.

The rub is that current California law already requires health care providers to follow timely access to care and right to translator rules. The right to timely access was originally part of California’s Knox-Keene Act, where consumers were assured, in broad language, that they would have access to services when they need it. Over the years, additional laws to clarify and enforce timely access requirements has been implemented. However, as it often happens, consumers are not aware of these laws or their statutory rights.

Empowering consumers with their legal rights also holds providers accountable. If consumers are aware of their rights, they can ensure that health care service providers are holding up their end of the deal. Californians will know that they do not need to wait months for a primary care or specialty appointment because of inadequate provider networks.

SB1135 (Monning) addresses this issue. The bill requires consumers to be notified of their right to timely care and language assistance. These notifications would be provided when someone first enrolls in a health plan, including Medi-Cal plans, and when they renew each year. The information would also be provided in the Evidence of Coverage and in a health plan’s provider directory and internet website.

Knowledge is power – SB 1135 empowers consumers with the information they need to ensure that they receive care when they need it, and in a language they can understand. These two simple steps will make quality health care more accessible not just to those in my clinic, but to all Californians.

Existing timely access laws:

Urgent Appointments Wait Time
for services that don’t need prior approval 48 hours
for services that do need prior approval 96 hours
Non-Urgent Appointments Wait Time
Primary care appointment 10 business days
Specialist appointment 15 business days
Appointment with a mental health care provider (who is not a physician) 10 business days
Appointment for other services to diagnose or treat a health condition 15 business days

Jing Mai is an intern for Health Access based in the Oakland office. She graduated from UC Davis in 2016 with a B.S. in Neurobiology, Physiology, and Behavior and a B.A. in Economics.

[1] Simon F. Haeder, David L. Weimer, and Dana B. Mukamel. Health Aff July 2016 35:1160-1166;doi:10.1377/hlthaff.2015.1554

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