Tag Archives: Medicaid

Low-income Marylanders with disabilities file lawsuit over Medicaid delays

Last week, the Public Justice Center and the Homeless Persons Representation Project filed a class-action lawsuit against the Maryland Department of Human Resources to challenge longstanding delays in processing applications for and providing Medicaid benefits to eligible adults with disabilities.  For these low-income Maryland residents with serious medical needs, Medicaid is the only way they can afford critical doctor care and prescription drugs.

“No one should have to go through this,” said Mary Lou, the named plaintiff, who had been waiting for nearly a year for desperately needed medical benefits.  “It’s just wrong and I want to do my part to make sure other people don’t have to suffer and get sicker just because they don’t have the money or the insurance.”

Mary Lou lost her insurance benefits after her husband was laid off due to the economy.  Soon, she was unable to pay to see doctors to help her manage her disabilities.  Mary Lou had no other choice but to apply for Medicaid. Although an eligibility determination is supposed to be made within 60 days under state law, Mary Lou had been waiting for a decision for more than 233 days.

“Her case is typical of others I see everyday,” said Carolyn Johnson of the Homeless Persons Representation Project.  “People with serious medical conditions apply for Medicaid and then wait months, often more than a year, for the state to process their applications and provide benefits.  During that time they can’t afford to see doctors or afford testing and treatment, including prescriptions and medical supplies.  So they go without healthcare until serious conditions deteriorate and become acute or life-threatening, which often means they end up in the emergency room costing the state far more money.”

According to the state’s own report, as of December 31, 2012, there were 20,007 pending applications for MA-ABD statewide, meaning the state still had not processed and determined eligibility on these cases.  Of the pending cases, 9,940, almost half, were categorized as untimely due to “agency delay.”  Throughout all of 2012, the number of untimely pending cases never dropped below 8,300, indicating a severe and chronic backlog.

“These numbers represent real people, who are very vulnerable, very sick and need treatment,” said Camilla Roberson of the Public Justice Center. “These delays have been going on for years and are getting worse. The consequences are felt by every poor applicant whose health deteriorates each day he or she goes without needed care and by society at large when it pays for emergency room visits and hospitalization, as well as the lost potential for stabilization or recovery.”

Added Jenny Pelaez, an attorney from the National Center for Law and Economic Justice in New York: “The plaintiff, and others like her, are in dire need.  It’s unconscionable that any state, and especially Maryland — which is often thought to be at the forefront of healthcare reform — is keeping some of its neediest and most vulnerable citizens waiting for something as fundamental as healthcare access because of bureaucratic backlogs.  It’s a violation of law and basic human decency.”


Top court rejects Medicaid eligibility standard

Maryland’s highest court ruled today that Maryland’s health department used a too-strict standard in determining Medicaid eligibility for at-home health services—a victory for Legal Aid and AARP, which argued the case at the Court of Appeals.

“This is great news and  a victory for elderly and disabled people throughout the state of Maryland,” said Legal Aid senior attorney Mary Aquino, one of the attorneys who argued the case.

The decision vindicates the rights of people with dementia, who are low-income eligible and get health related services at home or in assisted living facilities, said Aquino, who represented 86-year-old Ida Brown, whose application was rejected from the Older Adults Waiver Program in 2005.

The decision could affect as many as 13,000 Marylanders who are either in the program or waiting for approval to apply.

“The court’s ruling is good for people like Mrs. Brown and her daughter, who was her caretaker for years,” said Bruce Vignery, a lawyer at the AARP Foundation Litigation, who also argued the case. “It’s great news for family members of people suffering from Alzheimer’s and older people in general.”

Brown suffers from Alzheimer’s, osteoarthritis, osteoporosis, elevated cholesterol levels, hypertension, bilateral cataracts and a benign brain tumor. The state argued Brown did not require constant care from a licensed healthcare professional, its standard for admission to the program.

The Court of Appeals affirmed a decision last November by the Court of Special Appeals, which held that the Maryland Department of Health and Mental Hygiene’s standard was stricter than federal eligibility requirements for the program, which allows people 50 and over to get Medicaid coverage at home or in assisted-living facilities for long-term services that are normally only covered in nursing homes.

“Maryland cannot set a higher bar for eligibility under the Older Adults Waiver Program than is prescribed by the federal government,” Judge Mary Ellen Barbera wrote in the intermediate appeals court’s reported opinion last year.

Joseph DeMattos, director of AARP’s Maryland office, called the decision “a very encouraging sign. A lot of Marylanders have been suffering under these unfair standards.”