Suit hammers huge Medicaid backlog, long waits

Every month, thousands of poor state residents go without health care coverage while their applications for Medicaid linger, without being approved or denied, for longer than federal law allows.

The numbers “tell the whole story,” attorney Sheldon Toubman said Tuesday at the start of a trial in Hartford centered on allegations that the state Department of Social Services doesn’t have enough workers to handle Medicaid applications within federally required time frames.

Assistant Attorney General Hugh Barber, representing DSS, said it’s not that simple. Many of the cases are delayed for allowable reasons, such as the applicant not submitting needed information. The work needed to grant an application for nursing home or home care coverage is now so burdensome that the federal time frame shouldn’t apply, he said.

And while there are still thousands of cases that are delayed, Barber said, DSS is making significant progress following a period of dwindling staffing and skyrocketing demand. In the past year and a half, the department has hired 220 eligibility workers who, along with other employees working overtime, have been reducing the backlog. The number of pending cases that are overdue has fallen from more than 10,000 last May to close to 3,400 earlier this year.

“The agency is making dramatic improvement,” and doing so with existing staff and resources, Barber told U.S. District Judge Alvin W. Thompson.

But Toubman, an attorney with the New Haven Legal Assistance Association, said those changes aren’t good enough, that DSS still needs more workers, and that the department is trying to blame the delays on applicants without providing any proof. He noted that DSS has never asked federal authorities for an exemption from the time frame for cases it now says are too burdensome to complete promptly.

“You can comply with it if you have sufficient staff and you’re on top of requests for information and you’re on top of processing all the information that comes in,” Toubman said.

Testimony Tuesday included details of the case of Robert Davis, whose relatives struggled to provide care on their own while waiting six months to get Medicaid coverage for home care, and the experiences of a DSS worker in New Haven who said that even after DSS hired more than 200 people, workers are responsible for close to 1,400 cases and only staying afloat because of overtime.

“We’re desperate”

Davis has Alzheimer’s and needs to be watched constantly. His wife and daughter care for him, and last September, they applied for Medicaid coverage to pay for home care to help.

His case was described by Leanne Blakely, a paralegal who helped Davis’ family apply for Medicaid.

In Davis’ case, and most others, the state has 45 days to process a Medicaid application. In a relatively small number of other cases, when an applicant seeks to qualify because of a disability, the state has 90 days.

But, Blakely testified, it took close to 45 days before she heard anything from DSS. In November, she got a request for additional information. She submitted it within the required 10 days, she said.

As months passed without a decision, Davis’ needs grew. He was having more and more outbursts, and his wife was bearing the brunt of it.

“She was really needing a break,” Blakely said. “The family was calling me on quite a regular basis to say, ‘We really need help, we’re desperate. How much longer is it going to take?’”

Blakely said the case worker at DSS promised her if they could wait until the beginning of February, he could get through the case file or tell them if he needed more information. But that didn’t happen, and the attorney Blakely works for, George Bickford, requested a hearing.

The hearing was scheduled for April 10. On April 9, Davis was found to be eligible for Medicaid, six months after his application was first submitted.

How does that compare, plaintiff attorney Shelley White asked, to other home care cases her office worked on in the past two years?

“To be honest with you, it’s actually rather quick,” Blakely said. “Most of our home cares are taking eight months or longer to get any kind of benefits.”

Under questioning by Assistant Attorney General Rose McGovern, Blakely acknowledged that some documents DSS needed for the application weren’t submitted with the initial batch in September. Some documents, which Blakely didn’t initially know existed, weren’t provided to DSS until March 2013.

She later noted, under questioning by White, that DSS didn’t make clear what extra documents were needed for close to 45 days after the application was first submitted, and that had she known what was needed sooner, she would have gotten them to the department within 10 days.

No one argued that it doesn’t take a lot of documentation to qualify for Medicaid home care or nursing home coverage. Blakely brought with her the initial documents filed for Davis, a stack several inches thick. Among the requirements: five years’ worth of bank records and information about the income and assets of an applicant’s spouse.

Both of those requirements have been added since the initial time frame was set by the federal government, Barber said, suggesting that the 45-day limit should no longer apply. But if it does, he added, almost all of the overdue cases were excusable because of “unusual circumstances.”

Currently, about 82 percent of all Medicaid applications are now processed in a timely manner, Barber said.

“The department is doing reasonably well,” he said.

1,400 cases, overtime, and another lawsuit

Donna Velardi, an eligibility services supervisor at DSS’ New Haven regional office, testified that it’s very difficult to handle the volume of applications with the staff she has.

Workers in the unit handling adult cases in her office have about 80 applications each. But they’re also responsible for maintaining about 1,300 other cases — clients already receiving benefits whose cases need to be reviewed periodically.

“It may not seem like a lot, but it is when you consider all the other responsibilities,” Velardi said. Those include answering phones, covering for people on medical leave or vacation, and interruptions throughout the day.

Toubman noted that the department has cited the 220 people hired. “Hasn’t that helped you in the regional office in New Haven?” he asked.

“No, because they did not primarily come to New Haven,” Velardi said, adding that she believes they’re primarily working in three regional offices that are going to serve as call centers.

But she said there is one thing that’s helped tremendously.

“The only thing that’s keeping us afloat right now is overtime,” she said. It’s available for people to work on Medicaid and food stamp cases. This month, they’re supposed to focus on food stamps, she said, while the for the previous months, it was Medicaid.

Why has the focus changed? Toubman asked.

Because of that other lawsuit, and the number of overdue applications, Velardi said.

The other lawsuit was filed last year by attorneys at Greater Hartford Legal Aid. It targets delays in processing applications for the Supplemental Nutrition Assistance Program, formerly known as food stamps.

U.S. District Judge Vanessa L. Bryant issued a preliminary injunction order in that case Monday, requiring DSS to process all applications for food stamps and provide retroactive benefits to eligible applicants within federally required time frames. Bryant’s order gives the state one year to be in full compliance with all federal requirements for promptly determining an applicant’s eligibility, and sets a schedule for getting there.

Bryant wrote in December that there was evidence of an “ongoing, persistent systemic failure” to comply with federal law.