SATURDAY, OCTOBER 31, 2015 State ordered to act quickly on health case

Woman sued after agency said Medicaid file missing

A federal judge on Friday ordered the Arkansas Department of Human Services to act “as soon as possible” on a Medicaid application that a Brickeys woman filed more than 11 months ago.

U.S. District Judge Kristine Baker rejected an argument from department officials that they can’t act on Anita Walker’s application because they never received it after it was submitted through a federal website, healthcare.gov.

Baker said the officials could request the application information from the federal government or get the information directly from Walker.

The Human Services Department will appeal Baker’s order to the 8th U.S. Circuit Court of Appeals in St. Louis, department spokesman Amy Webb said.

“It is not our desire for any applicant to be left waiting for a decision on their eligibility, but in this particular situation, we do not have the information necessary to make a decision,” Webb said in an email. “We have [provided] her attorney with an easy way to get us that information.”

Arkansas has had widespread problems receiving information from applications submitted through the federal website, Human Services Department officials have said. At the same time, slow progress in completing the Medicaid program’s new computerized enrollment system has led to a backlog of applications.

As of Aug. 2, the most recent date for which figures are available, as many as 31,400 Arkansans had been waiting longer than 45 days for word on whether their applications had been approved.

Walker, 53, said in a law-

suit filed earlier this month that she first applied for coverage under Arkansas’ expanded Medicaid program on Nov. 24, 2014.

In January, she said, she called the Human Services Department and was told it couldn’t find her application, so she submitted another application.

She said she called three times to check on that application, but “did not receive any useful information.”

With the help of Jonesboro-based Legal Aid of Arkansas, which provides free legal help to low-income Arkansans, she requested an administrative hearing in May on why the department had not acted on her application within 45 days.

Latisha Meadows, an administrative review officer with the Human Services Department, wrote in July that the department didn’t have enough information to act on Walker’s application and that Walker should file an appeal with the federal Centers for Medicare and Medicaid Services.

At a hearing in federal court in Little Rock last week, Human Services Department

officials said Walker could appeal through the federal agency, with a request that the appeal be handled by the state. The federal agency would then forward records on Walker’s application to the Human Services Department, the officials said.

Susan Burton, the business process manager for the state’s Medicaid enrollment system, said Walker could also apply directly through a state website, access.arkansas.gov. If she were found eligible, the state would “work with her” to retroactively cover her medical expenses back to Nov. 24, Burton said.

In her ruling Friday, Baker said Human Services Department officials didn’t cite any written policy indicating that Walker could apply through the state website and receive such retroactive coverage.

Notices that Walker received through healthcare. gov told her she “may be eligible” for Medicaid and should receive information from the Human Services Department, Baker noted.

The notice told Walker to call the department if she didn’t hear from them and that she could appeal “if you have received a final determination and you think we made a mistake.”

Baker said in the ruling that she failed to “understand what language in the notices can be read fairly to advise Ms. Walker to appeal the ‘maybe decision.’”

Baker also questioned why the Centers for Medicare and Medicaid Services would need Walker to file such an appeal before transferring Walker’s records to the state.

“A system exists to transfer these records at the appeals stage, and that system has been implemented by the [Centers for Medicare and Medicaid Services] and [the Human Services Department],” Baker wrote.

“It is unclear why such a system is not available to conduct a fair hearing on a ‘maybe’ response at this stage of the application process.”

Human Services Department officials have said Legal Aid has not complied with the department’s request for the names and dates of birth

of clients whose applications have been pending for more than 45 days.

But Baker said the court record “includes very little information about this offer from [Human Services Department Director John] Selig and ADHS.”

“Mr. Selig and ADHS cite no authority that an aggrieved individual must accept something less than what the law provides,” the judge said.

Granting Walker’s request for a preliminary injunction, Baker ordered Selig to reinstate Walker’s administrative hearing request, gather the information needed to determine her eligibility and make a determination retroactive to Nov. 24, 2014.

“It’s great that the judge has forced DHS to comply with its obligations under the law,” said Kevin De Liban, a Legal Aid of Arkansas attorney who represents Walker.