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Medi-Cal DISCRIMINATES against Latinos— and that hurts EVERYONE with Medi-Cal

“They cancelled my appointment because I have Medi-Cal”

“No mother should have to lose a child because they have Medi-Cal”

California Gov. Jerry Brown UNDER FIRE for Medi-Cal failures

Have YOUR Medi-Cal rights been violated? TAKE THE QUIZ AND FIND OUT!


PROBLEM California Healthcare is in Crisis

WE ARE THE SOLUTION

June 6, 2015

CA State Auditor blasts Medi-Cal program

Gov. Brown Does Not Care…

Medi-Cal Beneficiaries June 16, 2015

“The Brown administration … has consistently opposed raising [Medi-Cal] rates.”

Healthcare Workers Low-Wage Earners

Lift Up CA is a campaign organized by SEIU-United Healthcare Workers West to raise the standards of living and health for all Californians. We helped lead the fight to raise California’s minimum wage to $15 an hour, and we’re leading the effort to fully fund Medi-Cal so all Californians can get the care we need.


PLAN

Raise the Standards of Living and Health

OUR JOB Expose the CRISIS with Our Stories

End Discrimination Fully Fund Medi-Cal SEIU-United Healthcare Workers West is one of the largest unions of hospital workers in the western United States, with more than 85,000 members. Our members are frontline caregivers whose mission is to provide quality care for patients, ensure access to excellent, affordable healthcare, and improve living standards for all workers.


Table of Contents 4 “NO MOTHER SHOULD HAVE TO LOSE A CHILD BECAUSE THEY HAVE MEDI-CAL” 6 MOTHERS ON THE FRONT LINES 8 Delay of care has BIG consequences “I FEEL LIKE WHEN THEY TOOK MY LEG, THEY TOOK MY LIFE FROM ME” 10 HEALTHCARE DELAYS ACROSS THE STATE 12 After one year with Medi-Cal, Delita knows…

“MEDI-CAL AND PRIVATE COVERAGE ARE NOT EQUAL” 14 WAITING FOR ANSWERS

“They wouldn’t tell me what was wrong with my son”

16 KNOW YOUR MEDI-CAL RIGHTS 18 HOW FAR WOULD YOU GO FOR YOUR FAMILY?

Ofelia has to travel 200 miles to see her doctor

20 Medi-Cal beneficiaries often travel TOO MANY MILES for care 22 JOSE DENIED CARE

“They cancelled my surgery when I switched from private coverage to Medi-Cal!”

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24 MEDI-CAL DISCRIMINATES against Latinos

26 Do YOU have

what it takes to be a

HEALTHCARE HERO? 28 We won a $15 minimum wage

NOW WE’LL FULLY FUND MEDI-CAL 30 TOGETHER WE CAN FIX MEDI-CAL “MEDI-CAL DOESN’T EVEN COME CLOSE TO PRIVATE COVERAGE”

32 HAVE YOUR MEDI-CAL RIGHTS BEEN VIOLATED? Take the quiz and find out!

12 26 HEALTHCARE HEROES

KNOW YOUR MEDI-CAL RIGHTS

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“No mother

M

y daughter Gaby loved to read, do math, and help other students who were having a hard time at school. But when she was 10 years old, that all changed. She started getting headaches, would throw up once or twice a week, and became withdrawn. At first I thought it was just something she ate or part of growing up, but then she began throwing up more and getting dizzy spells. That’s when I knew something was wrong with my

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little girl and that I needed to get her help. First the doctors told me it was a virus. Then they gave her stomach medicine. As time passed though, Gaby kept getting worse. She was eating less and less and getting dizzy and vomiting more frequently. Several times it got so bad that we rushed her to the emergency room. In the ER they just gave her more stomach medicine and sent us home. I asked them to run tests to find out what was really wrong with

my daughter, but they wouldn’t do anything else. It wasn’t until Gaby started throwing up once or twice a day that we were finally sent to a specialist. We had to wait four months to get seen, and when the specialist had Gaby admitted to the hospital for tests on her stomach, they still couldn’t find anything wrong. The hospital sent us home after a week, telling us, “Medi-Cal would have to pay a lot of money,” if we stayed. The week we came home from

Have YOU struggled to get care for your child?


should have to lose a child because they have Medi-Cal”

Gaby (far left) with her siblings before her illness.

the hospital, Gaby began to throw up over and over, almost without stopping. It was awful—something was clearly wrong. I took her back to our doctor and pleaded with her to do something. When we got to her office, she pulled me aside and said: “I need to talk to you alone.” That’s when I found out my daughter might have cancer. She made special arrangements for us to see a brain specialist who ordered a biopsy. After three more months of waiting for the test results, the specialist confirmed our worst fears: Gaby had brain cancer. The moment I heard those words, my body started shaking. I

Before Gaby died, her friends and family threw her an early quinceañera (15th birthday celebration).

started to question everything: Did I do something wrong as a mother? Why did we have to wait so long? Why did we have to fight so hard for someone to pay attention to Gaby’s illness? Could I have insisted more with the doctors? Did they not do their job? Did they not listen to me because I don’t speak English? Gaby underwent radiation and chemotherapy, but by then the cancer was too advanced. A year later, my little girl died. The people in charge of MediCal need to find out how their program actually works. They need to hear the truth. My daughter had dreams of becoming a teacher or a doctor. But now those dreams are

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Rosa recently traveled to Sacramento to share her story.

gone. There’s nothing I can do to bring her back. It’s an immense pain and I can’t find a way to escape it. Gaby was a very strong child—and she taught me to be strong. Even near the end, she would tell me not to worry because life would go on. So now I’m telling other moms like me to talk without fear because fear won’t get us anywhere. No mother should have to lose a child just because we have Medi-Cal.

—Rosa Gomez Orange County

LEARN MORE ON PAGE 32

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MOTHERS FRONT LINES ON THE

“My daughter was born prematurely with cerebral palsy and weighed only 1.5 lbs. We have to wait months for the treatments that keep her alive, like breathing machines and medication. It’s like her life doesn’t have value because she has Medi-Cal.” Esther Mendoza, Los Angeles

“My son EG lives with a disability because of complications at birth. The doctor actually said, ‘He got the care that you can afford with Medi‑Cal.’ I’ve been fighting for my son ever since—he motivates me to speak up for healthcare justice.” Linda Hunter, SEIU-UHW Member, Vallejo

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Are YOU a mother trying to protect your kids?


More and more mothers are seeing how a lack of Medi‑Cal funding harms our children. Now we’re sharing our stories so that other mothers don’t have to see their sons and daughters suffer. “My son Saul has cerebral palsy and suffers from severe seizures. It’s very sad when I try to get an appointment for him. They are happy to speak to me until they ask me what insurance I have. When I say ‘Medi-Cal,’ they say, ‘We can’t see patients with that’ or ‘You have to go on the waiting list.’”

Watch Analilia and Saul’s story: www.seiu-uhw.org/medi-cal

Analilia Jimenez Perea, Santa Rosa

“My daughter Pajia has special needs and I have spent years trying to get care for growths all over her body. Between the long wait for appointments, doctors not treating her, and trying home remedies, I am exhausted—but I’m still determined to fight for her care.”

Neng prepares home remedies for her daughter.

Neng Her, Fresno

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My son said to me:

“I feel like when they took my leg, they took my life from me�

Before 8

After

Have YOU faced delays getting care?


M

y son Jorge was 24 years old when he noticed a tiny lump on his leg. He’d always been very active—he loved playing soccer since he was a boy— so we went to the doctor right away to get the lump checked out. The doctor sent us to a specialist, but we had to wait four months for an appointment because Jorge has Medi-Cal. There, the specialist told us the bad news: Jorge had cancer and needed to be operated on. As the months passed while we waited for the surgery, the lump on Jorge’s leg kept growing and caused him so

much pain he had to quit his job. One morning, he became so weak he collapsed in the shower and I had to rush him to the hospital. It was only then that Jorge got the attention he needed. The ER doctor discovered that the tumor not only had grown to the size of an orange but had spread throughout his leg and to his lungs and heart. Our only option to save his life and stop the spread of the cancer was to amputate his leg and to remove part of his lung. Now, Jorge has grown depressed and almost never leaves the house. He can’t play

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soccer. He can’t work. He said to me recently, “I feel like when they took my leg, they took my life from me.” This is hard for me to share, but I’m speaking out to help others get over their fears and join me. The only way things will get better is if we share our stories and force the people in power to start caring for those of us who have MediCal. —Lorena Velazquez San Diego

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DELAY “I’ve been on a kidney transplant list for over

FOUR YEARS. This whole time I’ve been scared seeing other people on the list die while they wait.” Francisco Cisneros Yuba County

“My son Christian is autistic

and needs to see a specialist regularly to make sure his medications are right and help him communicate. But we have a hard time getting him appointments— sometimes he’ll go WEEKS without one. Without regular medical care and visits, his behavior gets out of control.”

Graciela Ocegueda, Oakland

“I was so happy when I got pregnant,

but I worried my diabetes would affect the baby. It took THREE MONTHS to see a doctor, and by then my high blood sugar had already hurt my baby. He passed away in the fifth month of my pregnancy. Now I can’t imagine ever having a child again because losing him still hurts so much.” Adriana Tinoco, Los Angeles

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Have YOU faced delays getting care?


Know Your Rights

across the state

YOU HAVE THE RIGHT TO PROMPT CARE California Depar tment of Manag ed Health Care, 28 CCR § 1300.67.2.2(c)( 5)

If you are in a Medi-Cal managed care plan, you should not have to wait more than 10 business days for routine primary care or 15 business days for specialty care.

“I was having stomach pains so bad that I couldn’t

even stand up some days. It felt like something was eating me from the inside. But for MONTHS I couldn’t see a specialist who took Medi-Cal. My family ended up rushing me to the ER where they found I had a colon infection and blockages in my pancreas. That delay nearly cost me my life.” Samuel White, Stockton

“We spent MONTHS looking for a doctor to treat my husband Thomas’s stomach

pains. When we finally saw one, he was diagnosed with liver cancer. Thomas died just one year later. Now my two children and I are alone. Every day I wonder if my husband might still be with us if he had received care sooner.”

Amalia Pascual, Fresno

“I had a lump in my breast, but it took SEVEN

MONTHS for Medi-Cal to enroll me. I got lucky— the lump wasn’t cancer. But every day I worried that it was and that I would die.”

Daisy Ramirez, Orange County

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After a long year spent trying to get care through Medi-Cal, Delita (center) is back on private coverage and enjoying life again.

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Have YOU gotten inferior care as a Medi-Cal


After one year with Medi-Cal, Delita knows…

“Medi-Cal and private coverage are NOT EQUAL” I

had health coverage through my job for years, and I always got good care. So when I was dropped from my plan and switched to Medi‑Cal, I worried about whether it would be as good. It wasn’t. Not even close. Just after I switched to MediCal, I tried to see a doctor to get my regular diabetes and thyroid medications. I called the doctor assigned to me but was told they didn’t have any openings for four or five months. Because of my medical conditions, it scared me to wait this long, but I didn’t know what else to do. A week before I was finally going to be able to see the doctor, they cancelled my appointment— with no explanation— and told me I’d have to wait another four months. I told them I had already

patient?

waited five months, and without medication, my thyroid levels and blood sugar can skyrocket to dangerous levels. Luckily, I was able to convince one of the doctors there to write me a prescription without seeing me. Still hoping to get an appointment with someone, I called the Medi-Cal office and found a different doctor who could see me in two months, instead of four. However, a few days before the appointment, it was cancelled because the doctor no longer accepted Medi-Cal. After a year of hassles and red tape with Medi-Cal, I was so relieved to get back to my private insurance. The difference is night and day. I’m lucky—I don’t have to go through all those headaches with Medi-Cal anymore. But I’m not done with Medi-Cal.

Now I’m sharing my story so that people who do have Medi-Cal get the same level of care that those of us have with private coverage. That’s the way it should be—and if enough of us speak up, that’s the way it WILL be soon.

CALL 888-920-4517

—Delita Barrow Sacramento

Know Your Rights Medi-Cal beneficiar

ies have the

RIGHT TO the SA ME ACCESS TO CAR E as ever yone else.

Medicaid Act, Section 30(A) Equal Access Pro vision

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WAITING FOR ANSWERS

Wang Xiong, Fresno

ONE MONTH

ER Trip #1: Wang rushes David to the ER where they flush his lungs, which are filled with fluid. The ER doctor prescribes a different lung medication.

Doctor’s Visit: David and his mother Wang visit the family doctor for David’s cough and chest pain. The doctor diagnoses David with pneumonia and prescribes medication.

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ER Trip #2: ER doctor claims previous diagnosis was wrong. He says David has a liver infection and prescribes an antibiotic.

David’s Condition Worsens: Fever and vomiting.

ER Trip #3: ER staff see how ill David is and admit him to the hospital for tests. He is diagnosed with valley fever, a fungal infection which can have complications such as severe pneumonia. He is sent back to his primary care doctor to get a referral to a lung specialist.

David’s Condition Worsens Further: Higher fever and extreme shivers.

Have YOU gotten inferior care as a Medi-Cal


17-year-old David Xiong came down with a hacking cough and pain in his chest. His mother Wang tried to get him help—and that’s when things went from bad to worse…

David’s doctor told Wang it would take three months to get seen by a specialist. When she protested, the doctor told her:

“David has Medi-Cal—this is how it works. If your son had private insurance, a specialist would see him tomorrow.”

3-MONTH WAIT to see specialist patient?

CALL 888-920-4517

Specialist Visit: The specialist examines David and clears him of valley fever.

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Are YOUR rights being violated?


1. You have the right to equal access to care You cannot be denied care because of your race, color, or national origin.

The Civil Rights Act of 1964, Title VI

2. You have the right to prompt care If you are in a Medi-Cal managed care plan, you should not have to wait more than 10 business days for routine primary care or 15 business days for specialty care.

California Department of Managed Health Care, 28 CCR § 1300.67.2.2(c)(5)

3. You have the right to care near your home If you have Medi-Cal managed care, you should not have to travel more than 30 minutes or 10 miles for primary care.

California Department of Health Care Services, 22 CCR § 53885

4. You have the right to the same access to care as everyone else, and the right to high quality healthcare Medicaid Act, Section 30(A)—Equal Access Provision

Sí Yog

Yes

5. You have the right to translation You should be able to communicate in your own language anytime you get medical care or talk to the Medi-Cal office.

California Department of Managed Health Care

CALL 888-920-4517

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How far would you go for your family?

I

n 2015 I started having back spasms so bad I could barely move, let alone keep up with my twin six-year-old boys! I went to my doctor who tried finding me a back specialist in Fresno, but none were willing to take me because I have Medi-Cal. After five months, we finally found a specialist who would see me, but he was north of San Francisco—nearly 200 miles away!

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Have YOU been forced to travel long distances


It seemed nuts to have to go so far when there are back specialists right here in Fresno. But my body was at the breaking point and my family needed me to get better. At that first appointment I found out I needed back surgery. That meant driving all the way from Fresno to San Francisco again—but this time staying a whole week. Traveling so far for the operation was hard on my family. My husband and sons had to stay in a hotel while I recovered. We couldn’t afford that, but it was our only option. Now the surgery is over and I feel better—but I still have to travel nearly 200 miles every three months for checkups. We leave the house at 4 a.m. and don’t get back until 6 p.m. I have to find someone to watch the boys, pay a lot of money for gas, and wake up extra early to pack meals for the road. We can’t afford any extra costs. I’m thankful that my back is better. My boys are seven now, and I’m able to keep up with them again and do all the little things around the house like I used to. But it seems crazy that people are forced to travel so far to get healthy—just because we have Medi-Cal. I don’t understand why we can’t just see the doctors where we live.

Ofelia is back to doing the things she loves— like playing with her sons and her dog—but it took many miles to get there.

—Ofelia Jardon, Fresno

for care?

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How far is Medi-Cal beneficiaries are often forced Connie Taylor-Smith drives her daughter from Oakland to Martinez up to three times a week to see a psychiatrist because none in their area accept their Medi-Cal coverage.

Michelle Price is forced to travel from Fresno to Chowchilla twice a month to see a doctor who treats her cancer.

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Ofelia Jardon has to travel from her home in Fresno to a doctor in Northern California every three months for back treatment.

Juan España Jr. and his family have driven from their home in San Jose to a hospital in Los Angeles every two weeks for the past six years for blood treatments that keep him alive.

Esther Castañeda was forced to travel from Sacramento to Mexico to get gallbladder surgery after her doctor cancelled the surgery because he doesn’t take Medi-Cal.

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Have YOU been forced to travel long distances for


TOO FAR?

to go LONG DISTANCES for care… Know Your Rights

Miles Miles 200 Miles 300 Miles 530 Miles You have the right to care near your hom e

CA Departm

ent of Healt

care?

CALL 888-920-4517

h Care Serv

ices

If you have Medi-Cal managed care, you should not have to travel more than 30 minutes or 10 miles for primary care.

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“They cancelled my surgery when I switched from private coverage to Medi-Cal� 22

Have YOU been denied care as a Medi-Cal


W

hen my job dropped my private coverage and I had to move over to Medi-Cal, everything changed for the worse. I was scheduled for a hernia operation but just days before I was to go in, my surgeon’s office found out I had to switch to Medi-Cal and cancelled it. I was in pain and really needed that surgery. I got my doctor to help me by calling several other surgeons, but none of them would operate on me because I had MediCal. That’s when I found out how bad Medi-Cal really is. My doctor’s nurse even told me once that my doctor was losing money just by caring for me. Months went by and my hernia grew more painful. It got so bad that I could barely walk. My doctor and I kept trying to find a surgeon to do the operation, but every time they heard I had Medi-Cal it was a dead end. Finally, after more than a year, I was able to get the surgery —but that was only after the local news did a story about my long wait. After the story was printed, I got a call from the Medi-Cal office. I know what real healthcare coverage looks like and Medi-Cal just doesn’t compare. No one should have to be featured in the newspaper just to get the system to pay attention to you. Everyone should be able to get the care they need when they need it.

Doesn’t this make you

SICK? Hospital CEOs reap MILLIONS every year —but Medi-Cal patients can’t get care!

—Jose Berumen, Oakland

patient?

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Thomas Priselac President & CEO Cedars-Sinai Medical Center

$4.6 * MILLION Christopher Van Gorder CEO Scripps Health

$4.1 MILLION ** Patrick Fry CEO Sutter Health

$6.3 MILLION * * IRS Form 990, 2014 (total compensation). ** IRS Form 990, 2013 (total compensation).

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MEDI-CAL

DISCRIMINATES AGAINST LATINOS—AND THAT HURTS EVERYONE WITH MEDI-CAL # OF LATINOS WITH MEDI-CAL

2.6 MILLION 2001

DROP IN MEDI-CAL PAYMENT RATES

As the number of Latinos with Medi-Cal has risen, payment rates to providers have dropped and fewer doctors can afford to treat Medi-Cal patients—and that makes it hard for ALL Medi-Cal patients to get care. Sources: CMS; DHCS; and CA Health Information Survey. Sources: Lewin Group and Urban Institute Studies; as a percentage of what Medicare pays.

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Have YOU gotten inferior care as a Medi-Cal


In the HOT SEAT

7.3 MILLION

PAYMENTS DOWN

2014

Year after year we’ve called on Gov. Brown (above) to fully fund Medi-Cal so that all Californians can get care—and year after year he refuses. Now he and Diana Dooley (below), Secretary of the CA Health and Human Services Agency, are under fire for massive discrimination against Latinos with Medi-Cal.

20% patient?

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HEAL

HER

“My husband is the reason I lead a team. I want to change things for him and others who suffer because they can’t get care.” Nemesia Cisneros Community Team Leader Sacramento

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Do YOU have what it takes to be a healthcare


THCARE LTHCARE

ROES “I look forward to the day when

our emergency room is just that —a place where people come

Anastasia Bernal and Rosalie Bernal SEIU-UHW members

when they have an emergency, not a place where they have to come for basic healthcare. That day will come when Medi-Cal is fully funded.” Michelle Ross SEIU-UHW Member

hero?

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WE WON A $15 MINIMU NOW WE’LL FULLY FUND SEIU-UHW member Dora Alvarez, on winning a $15 minimum wage:

“Together we fought, we pushed, we worked like crazy, and we won. Because of our work, millions of Californians will have better lives.”

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Take action TODAY!


UM WAGE

MEDI-CAL “I never thought we’d be able to win a $15 minimum wage— but we did it! Next we’re going to do the same with healthcare by pushing Governor Brown and all the other elected officials to fully fund Medi-Cal.”

Irma Reynoso Community Team Leader Los Angeles

CALL 888-920-4517

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TOGETHER WE CAN FIX M “Growing up in the Philippines, my father set an example for me as a leader. Like him, I want to leave this world a better place than I found it. I believe we build stronger communities for tomorrow by making today’s children healthier. That’s why I want to fix Medi-Cal.” Jay Fermin, SEIU-UHW Member

“Most of my team works in the fields with me, so during our breaks we meet to plan. That’s how we’ve become such a strong team—we not only work together in the fields but we also fight together to make Medi-Cal better.” Maria Guadalupe Valdez Community Team Leader Fresno

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Take action TODAY!


MEDI-CAL GUADALUPE MARIBEL

was talking to elected leaders about problems with Medi-Cal before I even started.

and I have worked together for change in East LA, and we’re devoted to changing Medi-Cal for the better.

ALICIA’S

LILIANA

brings lots o f brains and a nimo to our team !

TEAM CAROLINA

worked on minimum wage with me going door-to-door, and now we’re onto Medi-Cal.

MY NAME IS ALICIA ORTIZ and I’m a Community Team Leader with Lift Up CA in Southern California. Check out my team of friends and neighbors who are pulling together to win for all Californians!

en to

MARIA has spok out ab ected leaders el get how hard it is to ildren care for her ch al. through Medi-C

CALL 888-920-4517

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Have YOUR Medi-Cal rights been violated?

S

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M

T W T

F

S

Take the Quiz!

Have you or a family member with Medi‑Cal ever been unable to get an appointment to see a doctor or specialist?

Yes

No

Have you or a family member ever been turned away by a hospital or clinic because you were a Medi-Cal beneficiary?

Yes

No

Have you or a family member with Medi-Cal ever waited more than a month to get care for a medical need?

Yes

No

Have you or a family member with Medi‑Cal ever had to leave the U.S. or travel more than 30 minutes/10 miles to get care?

Yes

No

Has your health or a family member’s health suffered because you were unable to get the care you needed through Medi-Cal?

Yes

No


If you answered YES to any of these questions, you can help expose the Medi-Cal CRISIS.

Call 888-920-4517 or go to www.seiu-uhw.org/medi-cal

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kids MARIA is not feeling well... Help HER GET TO the hospital!

Connect the dots

color the picture

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Paid for by Lift Up California, Sponsored by Service Employees International Union – United Healthcare Workers West, A Coalition of Non-Profit and Labor Organizations. 560 Thomas L. Berkley Way, Oakland, CA 94612.


Lift Up California Magazine