Class Action Alleges DSS Can’t Process Medicaid Apps In Timely Manner
(Updated 3:05 p.m.) The Department of Social Services having been “systematically stripped of workers” failed to process Medicaid applications in a timely manner, a federal class action lawsuit filed Monday by legal aid attorneys says.
One of the two named plaintiffs is just one of the nearly 5,000 Connecticut residents whose applications for Medicaid have been pending well beyond the 45-day period generally required for processing applications, the lawsuit says.
“At the end of November, 2011, nearly 55 percent of all of the Medicaid applications were pending beyond the federally-mandated time limits,” the lawsuit says.
As a result Paul Shafer, the lead plaintiff, “has been unable to access Medicaid coverage for his anti-seizure medication.”
The second named plaintiff Joshua Harder, is one of hundreds of individuals whose applications have been approved, but is subject to the spend-down requirement.
Although Harder provided his medical bills in compliance with the spend-down requirement for the six month period between July 1 to December 2011, he was not provided Medicaid benefits and has been unable to receive further medical treatment.
DSS workers not only cannot timely process applications, but they also cannot timely process Medicaid annual reviews, legal aid attorneys said in a press release. As a result, individuals who continue to be eligible for Medicaid and have timely submitted their annual redetermination forms are nevertheless routinely cut off of Medicaid.
But the Department of Social Services spokesman said filing a lawsuit may not have been the best way to handle this situation.
“We are disappointed that legal services has chosen to file a lawsuit that will consume precious time and resources, rather than working with us on practical approaches to re-investing in DSS,” David Dearborn, DSS spokesman, said in a statement. “It’s common knowledge that the agency has dealt with major, double-digit percentage staffing losses over the last decade and increasing monthly Medicaid (19.5%) and SNAP (81.0%) caseloads over the past five years. To meet these critical needs, we are working with the Office of Policy and Management to refill existing vacancies and hire additional staff; and we have begun the process of upgrading the entire IT infrastructure.”
“We realize of course that the state has had budgetary problems,” Shelley White, an attorney representing Shafer, said. “But even under these circumstances, states must comply with federal law if they want to continue to receive hundreds of millions of dollars of federal reimbursement under Medicaid. One of the most basic requirements of federal law is that applications for Medicaid must be processed timely, in a specified number of days, so that Medicaid is actually available when needed.”
Sheldon Toubman, another one of the attorneys with New Haven Legal Assistance Association, noted that “previous administrations seemed to not value the essential benefit programs administered by DSS and thus severely cut back on its staffing in successive budgets. It is unfortunate that Governor Malloy’s Administration and his Commissioner of Social Services inherited such a severely hobbled agency.”
“However, given his commitment to preserving the safety net, we are optimistic that Governor Malloy will step up to the plate and recognize the need to reverse these cutbacks and thus avoid jeopardizing federal funds,” Toubman said.
“As Commissioner Rod Bremby has emphasized, we can’t correct and resolve issues resulting from lack of investment over the past decade in a matter of months,” Dearborn said. “However, the Commissioner and agency are committed to doing so as promptly and as cost-effectively as possible.”
Toubman bristled at the notion that the lawsuit would tie up resources, since this has been an issue for years. As for the IT system, he said the earliest those improvements will be made is 16 months from now, “how does that help someone today can’t get onto Medicaid?” he wondered. He said what they need now is more staff. He suggested a bunch just retired in October and could easily be hired back.