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Medicaid applicants facing 'tremendous hurdles'?

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When filing a claim for Medicaid disability benefits, the process sounds straightforward: Complete an application that includes all disabilities that would make the case that you deserve the benefits. If your application is deemed sufficient by a Medicaid Medical Review Team, you get the benefits. If not, you receive a one- or two-page letter that includes information about how you can appeal.

But it’s what the applicant is allowed to present at the appeal that is at issue in an ongoing case that was decided by the Indiana Court of Appeals July 21 and is currently on petition for transfer to the Indiana Supreme Court. The most recent brief was filed Sept. 23.
 

medicaid Gavin Rose is lead counsel in a case involving appeals of denials of Medicaid benefits. Jacquelyn Bowie Suess assisted him. They’ve petitioned for transfer. (IL Photo/ Perry Reichanadter)

In its decision in the case Anne Waltermann Murphy, et al. v. William Curtis, et al., No. 49A04-0909-CV-503, the Court of Appeals found in favor of Anne Waltermann Murphy in her official capacity as secretary of Indiana Family and Social Services Administration, and Patricia Casanova in her official capacity as director of the Office of Medicaid Policy and Planning of the Indiana Family and Social Services Administration.

Murphy and Casanova, represented by Indiana Attorney General Gregory F. Zoeller and deputy attorney general Frances Barrow, have maintained their position that an administrative law judge who hears an appeal of a denied application for Medicaid benefits does not need to consider any information that was not included in the initial application.

“Under the facts and circumstances before us, we cannot say that the FSSA’s interpretation of the applicable statutes and regulations is unreasonable, violative of any of the cited statutes or regulations, or otherwise constitutes a denial of due process. We therefore reverse the trial court’s entry of summary judgment in favor of the Class and remand with instructions to enter judgment in favor of the State,” wrote Indiana Court of Appeals Judge Paul D. Mathias. Judge Cale J. Bradford concurred, but the third member of the panel, Judge Patricia A. Riley, dissented with a separate opinion.

In her dissent, Judge Riley wrote, “I part ways with the majority’s conclusion that an ALJ’s refusal to consider evidence of conditions not disclosed on a Medicaid disability application does not violate federal Medicaid law and the Due Process Clause of the Fourteenth Amendment.”

“I believe that the current policy used by the ALJ to exclude any evidence not alleged in the original application but which could establish that the applicant is nevertheless entitled to benefits not only violates our basic notions of due process but also an ALJ’s duty to inquire,” she continued. “The very purpose of the Medicaid administrative hearing is to determine an applicant’s eligibility to receive assistance.”

In their petition for transfer filed Aug. 19, attorneys Gavin Rose and Jacquelyn Bowie Suess of the American Civil Liberties Union of Indiana made a similar argument.

Rose said these particular three plaintiffs – William Curtis, Gary Stewart, and Walter Raines – were named because they had similar ALJ decisions for different reasons after appealing their denials for Medicaid benefits. He said the ACLU included them in the lawsuit based on their particular ALJ decisions because “three cases over a short time span can convert to more in reality.”

In Curtis’ case, Rose said, his caseworker advised him only to report his mental health issues and not include his orthopedic problems. Stewart, who applied so he could receive medical attention, wasn’t diagnosed with his pre-existing condition of congestive heart failure until after his application because he didn’t know what was wrong at the time he filled out his application.

And Raines “either had trouble identifying his illness or he didn’t consider it disabling,” Rose said.

These issues are fairly common, said Adam Mueller, who has handled appeals of denials of Medicaid benefits as a staff attorney for Indiana Legal Services in Indianapolis. While ILS can’t get involved with this case because it is a class action lawsuit, he would speak about what he sees in Medicaid benefit appeals.

Most of the clients who’ve come through his door wanting to appeal filed their initial applications pro se, while some had help from a caseworker, social worker, or family member if they were unable to fill out the application on their own, such as in a case where the person has little educational background, a low IQ, or doesn’t know how best to explain how his or her disabilities would make them eligible for benefits.

“We start by gathering evidence, talking to the client, and determining if we think their case has merit,” Mueller said.

This includes evidence related to the person’s vocational history and medical history.

While he said ILS doesn’t represent every appeal, he did say ILS’ contact information is on the notice applicants receive when they are denied Medicaid benefits and many people find them that way.

If the person who calls them has “any evidence of a disability, we’ll take a look at it. And at least in the Indianapolis office, we end up representing the majority of the ones that come through,” he added.

He referred to an amicus brief filed by Mental Health America of Greater Indianapolis in support of the plaintiffs-appellees, which explains why the issues are misreported in the first place.

The brief’s first point is “… persons with mental illness can be subject to an unwelcome Catch-22 when applying for Medicaid Benefits: the very disorders that cause the Medicaid applicants to be impaired can prevent them from accurately identifying the full extent of their impairments.”

The brief goes on to explain that those who have mental illness may lack the insight to be aware of their own mental illness, and therefore may not consider it something that ought to be reported in an application.

When it comes to not knowing a diagnosis or being misdiagnosed, Mueller said he has seen clients who listed depression because they were given that diagnosis at one point in time, but the person’s psychiatric records may include evidence of bipolar disorder or “a host of other conditions,” he said.

The amicus brief also mentions stigma is not only a challenge in the application process, but “a key challenge in delivering mental health care to persons in need is having the person with the mental disorder overcome the perceived disincentives to seeking treatment.”

“And that could be the one debilitating condition that could prove they are disabled,” Mueller added.

Mueller said that he is aware of some cases where ALJs are willing to accept information not on the application “if they find a nexus between the condition listed and what the evidence is presenting at the hearing.”

In their response to the petition to transfer filed Sept. 13, attorneys for the state wrote “The Court of Appeals correctly held that limiting evidence at Medicaid disability hearings to conditions disclosed in the application does not violate Medicaid statutes or regulations, and is not a denial of due process. … The state reasonably expects applications for assistance to be complete, meaning all disabling conditions or impairments must be reported in the application. Who is in a better position than the applicant to know his or her impairments?”

Attorneys for the state also wrote that the briefs presented by the ACLU attorneys, the amicus brief by Mental Health America of Greater Indianapolis, and an amicus brief by Indiana Chapter of the National Academy of Elder Law Attorneys has “painted an extremely exaggerated picture of ‘the tremendous hurdles that a Medicaid applicant acting innocently will have in accurately reporting all disabling conditions at the time of application.’ … The regulations set out detailed provisions regarding initial investigations of applications for benefits. … Applicants may use authorized representatives to apply for benefits, and the agency will pay for the costs of medical examinations to determine an applicant’s eligibility,” the state wrote.

In their reply to the state’s response, filed Sept. 23, the ACLU attorneys reiterated their position that people with mental illness or physical disabilities are not necessarily in the best position to diagnose themselves, and that they have not overstated the difficulties some applicants face when completing an application for Medicaid benefits.•

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  1. OK, take notice. Those wondering just how corrupt the Indiana system is can see the picture in this post. Attorney Donald James did not criticize any judges, he merely, it would seem, caused some clients to file against him and then ignored his own defense. James thus disrespected the system via ignoring all and was also ordered to reimburse the commission $525.88 for the costs of prosecuting the first case against him. Yes, nearly $526 for all the costs, the state having proved it all. Ouch, right? Now consider whistleblower and constitutionalist and citizen journalist Paul Ogden who criticized a judge, defended himself in such a professional fashion as to have half the case against him thrown out by the ISC and was then handed a career ending $10,000 bill as "half the costs" of the state crucifying him. http://www.theindianalawyer.com/ogden-quitting-law-citing-high-disciplinary-fine/PARAMS/article/35323 THE TAKEAWAY MESSAGE for any who have ears to hear ... resist Star Chamber and pay with your career ... welcome to the Indiana system of (cough) justice.

  2. GMA Ranger, I, too, was warned against posting on how the Ind govt was attempting to destroy me professionally, and visit great costs and even destitution upon my family through their processing. No doubt the discussion in Indy today is likely how to ban me from this site (I expect I soon will be), just as they have banned me from emailing them at the BLE and Office of Bar Admission and ADA coordinator -- or, if that fails, whether they can file a complaint against my Kansas or SCOTUS law license for telling just how they operate and offering all of my files over the past decade to any of good will. The elitist insiders running the Hoosier social control mechanisms realize that knowledge and a unified response will be the end of their unjust reign. They fear exposure and accountability. I was banned for life from the Indiana bar for questioning government processing, that is, for being a whistleblower. Hoosier whistleblowers suffer much. I have no doubt, Gma Ranger, of what you report. They fear us, but realize as long as they keep us in fear of them, they can control us. Kinda like the kids' show Ants. Tyrannical governments the world over are being shaken by empowered citizens. Hoosiers dealing with The Capitol are often dealing with tyranny. Time to rise up: https://www.theguardian.com/technology/2017/jan/17/governments-struggling-to-retain-trust-of-citizens-global-survey-finds Back to the Founders! MAGA!

  3. Science is showing us the root of addiction is the lack of connection (with people). Criminalizing people who are lonely is a gross misinterpretation of what data is revealing and the approach we must take to combat mental health. Harsher crimes from drug dealers? where there is a demand there is a market, so make it legal and encourage these citizens to be functioning members of a society with competitive market opportunities. Legalize are "drugs" and quit wasting tax payer dollars on frivolous incarceration. The system is destroying lives and doing it in the name of privatized profits. To demonize loneliness and destroy lives in the land of opportunity is not freedom.

  4. Good luck, but as I have documented in three Hail Mary's to the SCOTUS, two applications (2007 & 2013),a civil rights suit and my own kicked-to-the-curb prayer for mandamus. all supported in detailed affidavits with full legal briefing (never considered), the ISC knows that the BLE operates "above the law" (i.e. unconstitutionally) and does not give a damn. In fact, that is how it was designed to control the lawyers. IU Law Prof. Patrick Baude blew the whistle while he was Ind Bar Examiner President back in 1993, even he was shut down. It is a masonic system that blackballs those whom the elite disdain. Here is the basic thrust:https://en.wikipedia.org/wiki/Blackballing When I asked why I was initially denied, the court's foremost jester wrote back that the ten examiners all voted, and I did not gain the needed votes for approval (whatever that is, probably ten) and thus I was not in .. nothing written, no explanation, just go away or appeal ... and if you appeal and disagree with their system .. proof positive you lack character and fitness. It is both arbitrary and capricious by its very design. The Hoosier legal elites are monarchical minded, and rejected me for life for ostensibly failing to sufficiently respect man's law (due to my stated regard for God's law -- which they questioned me on, after remanding me for a psych eval for holding such Higher Law beliefs) while breaking their own rules, breaking federal statutory law, and violating federal and state constitutions and ancient due process standards .. all well documented as they "processed me" over many years.... yes years ... they have few standards that they will not bulldoze to get to the end desired. And the ISC knows this, and they keep it in play. So sad, And the fed courts refuse to do anything, and so the blackballing show goes on ... it is the Indy way. My final experience here: https://www.scribd.com/document/299040062/Brown-ind-Bar-memo-Pet-cert I will open my files to anyone interested in seeing justice dawn over Indy. My cases are an open book, just ask.

  5. Looks like 2017 will be another notable year for these cases. I have a Grandson involved in a CHINS case that should never have been. He and the whole family are being held hostage by CPS and the 'current mood' of the CPS caseworker. If the parents disagree with a decision, they are penalized. I, along with other were posting on Jasper County Online News, but all were quickly warned to remove posts. I totally understand that some children need these services, but in this case, it was mistakes, covered by coorcement of father to sign papers, lies and cover-ups. The most astonishing thing was within 2 weeks of this child being placed with CPS, a private adoption agency was asking questions regarding child's family in the area. I believe a photo that was taken by CPS manager at the very onset during the CHINS co-ocerment and the intent was to make money. I have even been warned not to post or speak to anyone regarding this case. Parents have completed all requirements, met foster parents, get visitation 2 days a week, and still the next court date is all the way out till May 1, which gives them(CPS) plenty of to time make further demands (which I expect) No trust of these 'seasoned' case managers, as I have already learned too much about their dirty little tricks. If they discover that I have posted here, I expect they will not be happy and penalized parents again. Still a Hostage.

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