(Photo by Adam Berry/Getty Images)
Over the past few years, the District has illegally dropped hundreds of elderly and disabled individuals from a medicaid program that provides in-home health care to those who depend on it. In a recent article, the Washington Post profiles Joyce McWain-Gray, a 56 year-old who was left paralyzed from the waist down from a spinal condition and found the help she needed from the District’s Elderly and Persons with Physical Disabilities Waiver Program. She’s just one tragic case of many people who have been dropped from the program without any real legal bearings:
The Washington Post found that the District cut 366 people from all or some of the services they may have been eligible to receive in the nine months ended March 2012, according to records on file at the D.C. Attorney General’s Office. About a third of those people died, the office said. The District doesn’t know how they died because the program doesn’t get copies of death certificates, officials said.
The program, which provides home health care for elderly and disabled people who make less than $2,130 a month, works with “about two dozen licensed home health-care agencies” on a contract basis and serves about 3,000 people who qualify for the program. However, officials from the city’s Department of Health Care Finance—who run the program—deny that they’ve unlawfully cut anyone from their homecare health benefits:
They said many participants lose their spots when contract case managers submit incomplete or late annual paperwork required by federal law. They said people can request an administrative hearing to fight the terminations and get back into the program if they are eligible. In the past two years, the District reinstated about 600 people, said Yvonne Iscandari, program director for the department’s Division of Long Term Care.
And even home health agencies that contract with the District — and take some of the blame — worry that the District’s bureaucracy puts vulnerable people in peril.
“We’re not totally innocent in this, but some of the processes they’ve implemented have put some of the patients at risk and the agencies at risk,” said Linda Davis, owner of Premium Select Home Care, which serves about 100 Medicaid recipients in the District.
But there’s a silver lining in all of this: The Post also reports that several organizations are providing free legal services to those who have had their medicaid benefits for this specific program dropped.
And, luckily, the push from University Legal Services and other organizations has led to having city officials investigate the matter to see if what the District had done was, in fact, illegal. As it turns out, the city attorneys found that “more than 300 people might have been improperly terminated from the program.” After tracking down those people, Health Care Finance, who are working with the District on resolving this issue, “found that 133 had died and 37 had entered nursing homes or other long-term care facilities,” with an “additional 95 placed on the basic state Medicaid plan.”
Much of this issue stems from the District not giving program participants enough of a notice of when the need to renew certification to continue receiving benefits for the medicaid waiver program. Health Care Finance is now working with the District to ensure all participants enrolled in the program will properly receive 90 and 30-day notifications for when they need to renew certifications or schedule a hearing to make sure they can continue to get the benefits they’re entitled to.
Still, some say the District really dropped the ball and more needs to be done:
Attorneys and advocates for Medicaid recipients say the District hasn’t done enough. People who don’t request a hearing can still lose their services because of the District’s administrative errors, Rifkin said.
