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Health Care Advocates Take Complaint Directly To Feds

by Christine Stuart | Jul 2, 2012 5:30am
(1) Comment | Commenting has expired
Posted to: Health Care, Legal

Paul Bass file photo

Sheldon Toubman, an attorney for New Haven Legal Aid, who authored the petition

A coalition of 16 health care advocacy organizations aren’t going to wait for the two legislative committees to decide the fate of more than 77,000 low-income adults using the state’s Medicaid program.

Instead, they’re petitioning the federal Centers for Medicare and Medicaid Services themselves to halt a implementation of the waiver that could potentially kick about 20,000 low-income adults out of the program. Letters went out on June 8 which warned those receiving the benefits that they may be kicked off if they don’t fit the new guidelines the state wants the federal government to approve. Advocates argue the state’s actions are premature, since the waiver has yet to be granted. 

The Department of Social Services is seeking the waiver because the population receiving state assistance through the program was about 45,000 just two years ago and has increased to more than 77,000. It argues many of those receiving assistance through the program are between the ages of 19 and 26 years old who live at home with their parents.

However, advocates point out there’s no hard evidence to suggest the state even knows how many of the recipients fall into that age group.

The waiver, which has to be approved by the legislature’s Appropriations and Human Services Committee by July 24, includes a $10,000 asset test, which says if you can be claimed as a dependent on your parent’s tax return then they will count your parents’ income and assets as if they are yours. It also limits the stay at a nursing home to 90 days. Currently, there is no limit on nursing home stays.

Collectively, if the changes the state is seeking are approved then the state will save about $52 million in 2013.

Last week, Gov. Dannel Malloy stressed that the program was not designed to cover the expenses of a college student’s health insurance plan, nor was it designed for people who have substantial assets.

“If your son’s or daughter’s college provides a basic medical coverage for $1,200 or $1,300, our taking on that expense is not what this program was designed for,” Malloy said.

The dust up between advocates and the Malloy administration was heightened earlier this month when advocates discovered those receiving assistance were asked to resubmit their information to the Department of Social Services. While, this sounds like an easy task, it can be daunting since it’s impossible to reach a DSS employee by phone and nothing can be submitted over the Internet.

Dianne Olson, the mother of a brain-injured adult son, told a legislative committee last week that she’s all too familiar with the notices her son will be kicked off the plan.

“This has happened at least thirty times to my son in the last 25 years that he has been with DSS,” she said. “I must drive to DSS, hand them the envelope, get it date stamped and have them copy the envelope and give me that as a receipt. What do all the clients do who cannot drive to DSS? How many get dropped for no reason?”

A class action lawsuit was filed back in January, which alleges that DSS can’t process Medicaid applications in a timely manner. DSS has admitted it has problems, including a computer system developed back in the 1970s. And advocates say even the 120 additional employees hired to help with processing applications, there are still individuals who are falling through the cracks and losing their health insurance.

“DSS’s waiver proposal ignores the severe problems that the agency already has in managing its existing caseload, and its inability to timely process Medicaid applications, a direct results of having far too few staff to process these cases,” the advocate’s petition to the federal government reads.

Asked last week if the Malloy administration is ready to say individuals who qualify for Medicaid won’t be kicked off the rolls, Ben Barnes, Malloy’s budget director, said no more than Citibank can guarantee all the participants under the TARP program were able to refinance their notes.

“Who knows what’s going to happen with individual cases,” Barnes said.

But he was quick to also add that “we will do our best to ensure the only people removed are those ineligible for the program.”

“We would prefer to error on the side of keeping people on the program in order to avoid kicking somebody off inappropriately,” Barnes said last Wednesday.

Rep. Toni Walker, co-chairwoman of the Appropriations Committee, said she understands the proposal to move forward with the waiver to save more than $50 million in the budget. However, she continues to get phone calls from individuals who have struggled to get through the redetermination process and have their coverage dropped.

“We don’t want to eliminate people in tremendous need,” Walker said last Wednesday.

Walker said she would like to look into a proposal that would have recipients come up for redetermination when they come up for their annual review. She said the state also needs to look at allowing its community partners to help with processing these applications.

“We can’t have everybody suffer because of the previous administration,” Walker said blaming the problems with the antiquated state agency on 20 years of Republican governors. 

“The changes that we’ve made do not affect the organizational struggles that DSS is having,” Barnes said. “They’re well involved in an upgrade that will allow paper to be maintained electronically.”

But those changes are unlikely to happen within the next year. Currently everything DSS receives is on paper.

But Sheldon Toubman, an attorney with New Haven Legal Aid, had another argument for why the waiver is a bad idea. He said it no longer makes sense to even move forward with these changes, since under the Patient and Affordable Care Act the federal government will cover all the costs of the program starting in 2014.

“These restrictions are not really necessary,” Toubman said Thursday at a press conference to celebrate the Supreme Court’s decision upholding President Obama’s health care reform law.

The federal government will cover low-income adults in Connecticut up to 133 percent of the federal poverty level starting in 2014. Those between 133 percent and 200 percent of the federal poverty level could receive subsidies if the state decides to participate in the Basic Health Plan.

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posted by: mbuatti | July 2, 2012  4:46pm

The mose important part of this story is “It also limits the stay at a nursing home to 90 days. Currently, there is no limit on nursing home stays.” 
Wow.  I predict another petition, this time from the nursing home owners, is already on its way to DC.  Or do they just use lobbyists to convey the message?