A federal judge has approved a proposed settlement agreement in a class-action lawsuit against the Indiana Family and Social Services Administration alleging that an agency policy that doesn’t allow certain Medicaid waiver enrollees to apply for services other than what’s been approved by their case manager is in violation of federal Medicaid law.
Bernis Boatman, by her daughter Diana Wilbur, filed the original action in February 2010 against the then-FSSA Secretary Anne Waltermann Murphy, and the directors of the Division of Aging and Office of Medicaid Policy and Planning, after their case manager did not submit a request for additional services to the Division of Aging. Boatman was enrolled in the Aged & Disabled Waiver Program, and was approved to receive certain services each week or month. When her daughter, who was her primary caretaker, became ill and unable to care for her mother as she had before, the pair asked for additional services from their case manager.
There is no mechanism for someone to request additional services beyond what they had already been approved for, and their class-action suit claimed they were unable to apply for these services because of FSSA policy. The class consists of anyone who is enrolled or will be enrolled in the ADW program operated by FSSA. The FSSA operates five Medicaid waiver programs approved by the federal government, including the ADW program. The Department of Health and Human Services may waive certain requirements of the Medicaid program for states that include as “medical assistance” home and community-based services that are provided to someone, who but for such services, would require the level of care provided in a hospital, nursing facility, or intermediate care facility for the mentally disabled.
The parties stipulated and agreed to enter into a settlement agreement in March 2011. Under the terms of the settlement, when case managers create waiver enrollees’ proposed cost comparison budget and plan of care to submit to the FSSA for approval, case managers must submit a request for services for whatever amount and type of service each waiver enrollee desires. Case managers will be trained that they are now required to submit these requests to FSSA, and if for some reason, the case manager refuses or does not submit the request for services, the waiver enrollee may contact FSSA directly.
Judge Jane Magnus-Stinson in the Southern District of Indiana approved the proposed settlement in Edna Chadwell, et al. v. Michael A. Gargano, et al., No. 1:10-CV-158, finding it to be fair, reasonable and an adequate resolution. The plaintiffs are receiving everything that they could obtain through a final judgment in their favor in the settlement, she wrote, and this settlement spares the continued expense of litigating the matter.
The defendants, who deny all the allegations against them, also agreed to pay $16,000 in attorney fees to the American Civil Liberties Union of Indiana, who represented the plaintiffs. The parties have 60 days from July 21 to jointly file a status report regarding the ultimate dismissal of the case.