Woman sues state over untimely insurance enrollment

July 21, 2016

A lawsuit filed Thursday alleges the state ignored federal law requiring it to provide health insurance coverage within a reasonable time frame and must retroactively pay for an Elletsville woman’s medical bills.

Indiana Legal Services Inc. filed the lawsuit in Monroe Circuit Court on behalf of Regina Malloy, 50, who applied for enrollment in the Healthy Indiana Plan Dec. 20, 2015. Family and Social Services Administration denied her application under the disabled category in February, but did not decide whether she was eligible for HIP 2.0, according to the suit.

The lawsuit alleges that federal law requires FSSA to determine an applicant’s eligibility for HIP 2.0 within 45 days of the application date. Malloy appealed the untimely determination, which led to an administrative law judge in May affirming the disabled category ruling and directing the agency to assess Malloy’s eligibility for HIP 2.0, the complaint says. But the ALJ never determined the effective date of HIP coverage for Malloy, according to the lawsuit.

Malloy claims federal law mandates that FSSA make corrective payments retroactive to the date of the incorrect eligibility determination when someone successfully appeals an incorrect decision.

“Our client is several thousand dollars in debt as a result of the State’s failure to process her application in a timely manner,” said Katherine Wood, staff attorney for Indiana Legal Services. “Ms. Malloy provided everything needed to establish her HIP eligibility when she applied. The State took more than six months to enroll her in the plan, during which time she continued to receive needed medical services without coverage.”

FSSA did not respond to a request for comment by IL deadline.


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