The Colorado Medicaid program says it is taking “immediate actions” intended to correct widespread delays and erroneous terminations of health benefits that have left people with disabilities without coverage.
The list of actions — laid out in a recent memo to Medicaid recipients — are meant to “stabilize” a program called “long-term services and supports,” which includes in-home caregivers for people with chronic conditions and severe disabilities.
The move comes after the state program was accused of discriminating against people with disabilities who say they have been kicked off Medicaid because of documentation issues even when they’ve repeatedly submitted the required documents. Two agencies — the Colorado Center on Law and Policy and the National Health Law Program — filed a civil rights complaint against Medicaid last month, alleging that delays and convoluted policies were leaving some of Colorado’s most vulnerable people stranded.
The memo, shared with Medicaid recipients last week by the Colorado Department of Health Care Policy and Financing, included a list of actions intended to prevent people from losing services because of computer or paperwork problems.
“We hear you, and we are taking action,” it said.
Medicaid officials said they are helping counties review cases in which people’s services were terminated. Making sure people with long-term services, which include in-home caregivers for people with intellectual and developmental disabilities, is a “top priority,” the memo said.
Other plans are to quickly process a backlog of claims and temporarily pause terminations “for all reasons” for two months after a client’s benefits are set to expire, except for people who have moved out of state or died. If a person’s documentation is still not in order after two months, counties can extend services further by using a “good faith extension,” according to the memo.
The pause on terminations was a request made in the civil rights complaint, which accused Colorado Medicaid of violating the Americans with Disabilities Act.
Dozens of families have complained about losing their benefits for reasons they don’t understand. Some said they received notice that their files were missing documentation, but those notices don’t explain what is missing. Many are parents who are caring for children or adult children 24/7 and rely on help so they have time to work or sleep.
The Medicaid program said the processing delays and wrongful denials are the result of an overwhelmed system — counties across the state are dealing with an increased workload after the end of the federal public health emergency, while at the same time, the state adopted a new IT system and overhauled its structure.
Woes continue for Medicaid recipients
While the state agency tries to solve its problems, Medicaid recipients told The Colorado Sun they are on edge as they wait for their benefits to be restored.
Tanisha Vasquezbanks, 32, received house cleaning services through Medicaid for about five years. But in November, the company that provided the service called and said they hadn’t been paid by Medicaid for the month of October.
The service stopped the next week.
Vasquezbanks struggles to keep her apartment clean because she has achondroplasia, a bone-growth disorder that results in dwarfism. The condition makes it hard for her to do routine daily tasks.
“I have small limbs,” she said. “My hands can’t hold a whole lot.”
The in-home service was important. “It basically saved me from getting evicted,” she said.“My neighbors were complaining that there was a smell coming from my apartment.”
Her uncle is considering paying out of pocket to hire a cleaning service.
“I still have a pile of dishes that I need to put in the dishwasher,” Vasquezbanks said. “I still have a pile of trash in my room and I’m struggling to keep the bathroom clean and everything else. What I would like to know from Medicaid is, why are they letting folks with disabilities fall through the cracks?”
One Medicaid recipient who had a stroke, lost his job and driver’s license, and now has a visual impairment, recently lost coverage for reasons his family has yet to figure out, said his sister, who didn’t want her name used for fear she would be retaliated against by the insurance program. The 64-year-old man moved into a group home last year that specializes in caring for people with brain injuries.
The family’s understanding was that Medicaid would pay for the care, in part by using his Social Security disability funds. But the state Medicaid program canceled his coverage and the family doesn’t understand why, the sister said.
The family has spent $4,000 so far on an attorney. “The group home is reaching out, we’re reaching out, the attorney is reaching out and we’re still not getting anywhere with getting his Medicaid reinstated, and it should never have been disqualified in the first place,” the sister said.
To make matters worse, the assisted-living facility has not been reimbursed for any services it provided since his insurance was abruptly terminated in May.
At this point, Medicaid owes the group home almost $90,000. If Medicaid does not reimburse the group home by the time it is owed $100,000, the facility said it would have to evict him, his sister said.
That means he is on track to be removed from the home in about eight weeks, if Medicaid does not reimburse the facility by then. “And then what?” she asked.
Medicaid officials had told the family that for the man to continue to be eligible for Medicaid, the family needed to set up a special needs trust and an income trust. They did both, and provided proof multiple times to Medicaid.
But instead of approving his benefits, the state keeps asking for the same documents, the sister said.
“Profound concerns” about the new system
The federal agencies that received the civil rights complaint on Feb. 21 have not officially responded. They are the Office for Civil Rights in the U.S. Department of Health and Human Services, the U.S. Department of Justice, and the Centers for Medicare and Medicaid Services.
The Colorado organizations that filed the complaint have been corresponding with the federal human services department to assist in its investigation, they said. The organizations also sent additional concerns to the federal agencies Feb. 28, alleging that the state Medicaid program had been made aware of the problems “for quite some time.”
The supplemental filing included a Jan. 10 letter to Medicaid from the Colorado Department of Human Services Directors Association and Colorado Counties Inc. The two agencies expressed “profound concerns about the current state of the system,” including an “inability to produce accurate data.”
The filing also included an Oct. 6 letter to Gov. Jared Polis from Stellar Care and Services, which provides services for people with intellectual and developmental disabilities who receive Medicaid coverage. The agencies and others like it work with counties and regional entities called community centered boards, which help Medicaid recipients set up care.
The letter noted, among other problems, that “provider agencies often are unable to even identify a case manager for weeks at a time” and that they face an “endless string of auto responders saying they are short staffed” and “voicemails that are never returned.”
People concerned about their Medicaid coverage can find more information online on resource sites set up by the Colorado Department of Health Care Policy and Financing and the Colorado Center on Law and Policy.