NM Political Report: Thousands of overdue applications still eligible for Medicaid payment0

Republished with permission from the NM Political Report. Click here to read the original article here.

By Joey Peters

An advocacy group says data in a legislative report confirms suspicions that a majority of pending Medicaid applications in the last two years were eligible for benefits.

For Sovereign Hager, a staff attorney with the Center on Law and Poverty, the fact that the vast majority of those applications were still eligible for benefits is vindication of her organization’s legal battles with the state on the issue.

According to figures from the state Human Services Department, which administers the federal Medicaid and Supplemental Nutrition Assistance Program, the department saw 223,000 overdue renewal applications for Medicaid benefits between May 2014 and December 2015. The state agency estimates 97 percent of those applications met Medicaid requirements, despite being overdue.

“These overdue cases are the ones HSD would like to close for procedural reasons,” Hager said.

She’s referring to a May 2014 court order that barred HSD from automatically denying unprocessed Medicaid and SNAP cases. The state agency had been automatically denying all cases that it hadn’t processed within 30 days ever since it changed its IT servers in the fall of 2013.

That court order came after the Center for Law and Poverty filed a legal motion to force HSD to follow requirements from a 1991 consent decree born out of a lawsuit against the state.

The lawsuit, filed in 1988 by Debra Hatten-Gonzales, accused HSD of jeopardizing Medicaid and food stamp eligibilities. The Center on Law and Poverty contends that in 25 years, HSD has never properly followed the consent decree.

Next week a federal judge will hear the Center’s motion asking for HSD to be found in contempt of court. The Center wants the judge to appoint independent expert to oversee key functions of the state agency until the state complies with the consent decree. Some lawmakers are joining in on the call for independent oversight.

“It really is a concern,” state Sen. Howie Morales told NM Political Report. “HSD is not addressing these issues unless a court orders them to.”

Though Hager contends the eligible overdue Medicaid applications since 2014 came thanks to the lawsuit, HSD attributes only 3 percent of them to the ongoing litigation. The state agency attributes the rest of overdue applications that otherwise meeting benefit eligibilities to Medicaid expansion from the federal Affordable Care Act.

A spokesman for HSD didn’t return a voicemail left Thursday by NM Political Report seeking comment.

The memo also estimates the lawsuit has cost the state $5.4 million since 2014. Most of that money—$3.4 million—is from administrative costs. The rest come from additional Medicaid costs.

The Legislative Finance Committee report also warns that an appointed independent monitor could “pose a significant financial risk.”

Morales acknowledges that costs are “a concern” but “not an underlying issue.”

“The underlying issue is HSD not following the law,” Morales said.

It’s a contention that HSD, which has accused the Center on Law and Poverty for not being “cooperative” or “constructive” with the process, doesn’t agree with.

In an April 11 letter to the Legislative Finance Committee, HSD Secretary Brent Earnest writes that his department “is in substantial compliance with the Debra Hatten-Gonzales court orders” and has made recent efforts to “streamline the application process via online and over-the-phone applications.”

“The department has put together a multi-disciplinary team of individuals that are focused on meeting the requirements of the DHG lawsuit,” Earnest wrote. “It is the department’s plan to continue to comply with the requirements of the consent decree and disengage from the lawsuit as soon as possible.”

The Legislative Finance Committee compares the potential independent oversight of parts of HSD to what recently happened to the California Department of Corrections. There, an independent monitor has overseen the state’s prison health care since 2006. That year, the oversight cost the state $882 million. By 2009, the costs skyrocketed to nearly $2 billion.

But Hager says this comparison is unfair. Instead, she refers to “churn”—known as the process when people eligible for benefits have an application rejected and then reapply—as in itself costly to a state.

This type of churn in Philadelphia cost Pennsylvania $9 million in “unnecessary administrative costs,” according to a 2015 Center on Law and Poverty analysis,

“Were it not for the lawsuit, those people would have reapplied and it would have cost the state money,” Hager said.

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