“WHAT WE’VE GOT HERE IS . . . FAILURE TO COMMUNICATE!”* by Kevin Williams
“WHAT WE’VE GOT HERE IS . . . FAILURE TO COMMUNICATE!”*
by Kevin Williams
June is Effective Communication Month. CCDC has been telling you about the importance of the ADA requirement that government entities called “public entities” “shall take appropriate steps to ensure that communications with applicants, participants, members of the public, and companions with disabilities are as effective as communications with others.” That’s the law. And it makes sense. What good is it to provide and receive information for all of the programs, services and benefits of a government entity if we don’t understand each other? Our Legal Program cases recently have shown you police and jailers arrest and detain people who are deaf based on “gestures” and “handwritten notes” without considering a deaf person who speaks ASL and never learned English. We have also told you about CCDC’s Person of the Month, Anne-Marie Mokritsky-Martin, and her efforts and CCDC’s to address the effective communication issues surrounding individuals with cognitive disabilities.
Governments don’t make mistakes, right? Unfortunately, our state and local governments can’t seem to communicate anything effectively. Let’s take, for example, oh...let’s say...the Department of Health Care Policy and Financing (“HCPF”) and maybe Arapahoe County Department of Human Services (“ACHS”). Let’s make our example real concrete and talk about, oh...let’s say...Kevin Williams, the Legal Program Director for the Colorado Cross-Disability Coalition.
The story – buckle up, you might be here awhile:
Since 2000, I have been working and maintaining Medicaid eligibility under the 1619(b) work incentive program.** Everything was going along swimmingly until . . .
In October of 2011, I received a letter from my caseworker reporting my quarterly income (“Labor and Employment Letter”) telling me that my Medicaid-eligibility will change because of my income. The letter didn’t terminate my benefits, but certainly made me wonder what was coming around the bend.
On 11/14/2011 I wrote to my caseworker politely reminding her of my continuing
Medicaid eligibility pursuant to the 1619(b) program.
On 11/17/2011, my caseworker left me a voicemail letting me know that she had no idea that “the system had shut [me] down” (?!) and basically telling me that the system that reports income has no way of knowing about my 1619b status and therefore there’s really no way to make the systems speak to each other, and therefore, no way to prevent this from happening to people in the future. Great. Oh, and she “reopened” my case (??!!). Comforting.
I received another “Labor and Employment Letter” dated 12/3/2011 telling me the same thing as before.
On 12/7/2011, I submitted my annual redetermination notice packet and specifically requested “a written determination of my continuing Medicaid eligibility as soon as possible.”
On 12/19/2011, I sent my caseworker a letter demanding an explanation for the continuing Labor and Employment Letters.
I received a letter dated January 25, 2012 (page 5 of the link) from ACHS TERMINATING my benefits on October 31, 2011. Not a typo, you read it correctly. Terminating them three months ago. The letter based this determination on rule 10 CCR 2505:10-8.100.7.A.2.f. Look it up. Wait, you can’t. It doesn’t exist. Really. There is no ‘f’ under 8.100.7.A.2.f.
Then I got a letter from my caseworker dated 1/26/2012 (page 20 of the link) that apologized for the mess and included a Notice of Action (dated 1/25/12) (page 21 of the link) stating that I did, in fact, have Medicaid. I might have been satisfied with this Notice of Action, except that it only gave me benefits from 1/1/12 through 2/29/12! Excellent. I can rest easy for one whole month!
This story is wrought with lots of details and dates, so allow me to summarize for you:
· First, how can a determination be made on 1/25/2012 that my benefits “will end” on 10/31/2011? I’m pretty sure I received the benefits.
· Second, my countable income is not above the allowable amount because 1619(b) specifically authorizes income higher than the usual Medicaid limit.
Third, although the county is required to cite the rule it uses to make a determination, the cited rule “8.100.7.A.2.f” does not exist.
Fourth, how can the 1/25/12 notice from ACHS be valid when on the same day I was sent a Notice of Action from HCPF authorizing full Medicaid benefits and a letter from my caseworker explaining their mistake?
Whatcha gonna do? On 2/1/2012, I sent a letter to every person at ACHS and HCPF we could think of explaining why they were wrong and asking them to fix it.
On 2/2/2012, I appealed. You have no choice. If you do not, you lose your benefits. I had to appeal both the 1/25/12 ACHS notice and the 1/25/12 HCPF Notice of Action. The latter only authorized temporary Medicaid benefits through 2/29/12 at which time I would be ineligible again.
“Don’t worry, we are working on a fix.”
Responses to my 2/1/2012 letter included:
An email from the HCPF Client Eligibility Coordinator on 2/6/2012, “I wanted to let you know we are looking into this. Please feel free to call or email I me with any further questions or concerns.” Comforting.
An email from the ACHS CO Works Administrator on 2/2/2012:
Recently the State implemented a change in the Colorado Benefits Management System (CBMS) whereby Medicaid clients' earned income, as reported to the Colorado Department of Labor and Employment, is automatically updated to the case in CBMS. You are eligible for Medicaid under your 1619(b) status, and due to this your earned income is exempt in determining eligibility, nor are you required to establish an income trust. However, as a result of this new programming change, your income is being added to the case and subsequently shuts down because you do not have an income trust set up.
We submitted a ticket to the State CBMS help desk on 11/17/11 regarding this issue.
(That’s the ticket!)
Another email from the HCPF Client Eligibility Coordinator on 2/6/2012:
After researching this case we discovered that this is an issue within CBMS. We have begun work to get this remedied however; we do not have an estimated fix date at this time. We do have a work around that can be used in the interim. . . . Kevin’s benefits have not been terminated in the system yet - they are just scheduled to be terminated. But with the work around they won't ever be actually terminated.
(Oh...My benefits are “just scheduled to be terminated.” No worries then. And we got a “work around.” Don’t know what that is, but it sounds official.)
So then, on 2/7/2012 ACHS responds to my annual redetermination approving my Medicaid as of 1/1/2012.
Yay! They fixed the problem. Or not...
I received yet another Labor and Employment Letter dated 3/1/12.
AND THEN (you aren’t gonna believe this!) I received another letter from ACHS! This one was dated 3/2/12 (page 5 of the link) and it TERMINATED my benefits on 10/31/2011! AND ALSO ON 3/31/2012! It’s ok if you’re confused by this. We all were. My benefits were being terminated on two different dates, one in the past and one in the future.
Whatcha gonna do? We appealed again.
But wait...everything is fine...they fixed it again....
I received another letter from ACHS, this one dated 3/14/2012 stating that my Medicaid eligibility was approved as of 6/1/2003. (o . . . k . . .?)
And then another letter arrived, this one dated 3/15/2012 stating that my Medicaid eligibility was approved as of 12/12/2007.
I received a letter from my caseworker’s supervisor dated 3/21/2012 (page 25 of the link) saying:
This letter is in response to your request for a hearing regarding your Long Term Care (LTC) benefits.
Your LTC and Adult Medicaid are currently open and approved . . . . we have not taken action to discontinue your benefits at this time, and have no plans to do so . . . . Additionally, your benefits closed due to a wage verification interface from the Income and Eligibility Verification System (IEVS). This closure was in error and has been corrected. CBMS Help Desk tickets have been entered with the Office of Information Technology, but have not been resolved as of this writing. Unfortunately IEVS hits may continue to close your case on a quarterly basis, and we are doing what we can to correct these closures in a timely manner so they do not effect your medical benefits.
As if any of that was supposed to make sense to me. At any rate, I figured the problem was, once again, solved.
But then (yes, the story keeps going) I received a letter from ACHS, this one dated 6/1/2012, (page 5 of the link) TERMINATING my benefits on 12/31/2011 AND ON 6/30/2012.
Look familiar? And just in case they got that one wrong...
I received yet another Labor and Employment Letter dated 6/2/12. And another letter from ACHS dated 6/18/2012 (page 7 of the link) terminating my benefits on 6/30/2012.
Whatcha gonna do? We appealed.
I have been kicked off of Medicaid four times in the last six months. I have also received written correspondence from three ACHS officials and the HCPF eligibility coordinator saying I am eligible for Medicaid under 1619(b) and it was their mistake. I even received a Notice of Action from HCPF saying I had continuing eligibility.
Thankfully, I am a lawyer, my boss is CCDC Executive Director Julie Reiskin, and I am represented by Legal Program attorney Andrew Montoya, who is assisted ably by paralegal and CCDC Legal Program Assistant Briana McCarten. Fortunately, we are aware of the appeals process. But this mess is ridiculous and taking an enormous amount of time. CCDC is very concerned for others who have been subjected to this problem who do not have lawyers and are not aware of the appeals process.
Given the conflicting letters I have received, including multiple assurances that my Medicaid will not be terminated, it would be easy to think I could just stop filing appeals. But I can’t. Every time I get a notice threatening termination, I must appeal, request continuing benefits and request a hearing. This has happened now four times despite all of the assurances of a “fix.” It seems likely it will happen every quarter when the Labor and Employment Letters come, and I get “kicked off” again.
Each time this happens, we request the OAC consolidate the appeal with the first one.
This has taken up CCDC Legal Program time and continues to take up the time of the Office of Administrative Courts. If I miss one appeal deadline or one deadline for requesting continuing benefits, I could lose my Medicaid. It is within the power of HCPF to fix the problem. ACHS has asked HCPF to do so. HCPF refuses.
Based on information recently obtained from HCPF, CCDC believes there are as many as 634 1619(b) Medicaid-eligible clients in Colorado. We can’t even get a straight answer on that. If that is so, each of them is likely to be receiving the same nonsensical letters I have each quarter. We do not know how many have had their Medicaid benefits terminated.
If our state and local government agencies cannot communicate something as straightforward as whether I am 1619(b) eligible without all of these conflicting communications, how can we ever expect them to get their obligations under the ADA right?
Information about this case, and copies of the appeals filed can be found at http://www.ccdconline.org/case/1592.
*The reference is to a line in the movie “Cool Hand Luke,” starring Clint Eastwood. I realize many of us in the disability community are not big fans of his, but if the reference fits....
** To be able to earn income in excess of usual Medicaid limits and keep Medicaid, the person must:
Have been eligible for an SSI cash payment for at least 1 month;
Still meet the disability requirement; and
Still meet all other non-disability SSI requirements; and
Need Medicaid benefits to continue to work; and
Have gross earnings that are insufficient to replace SSI, Medicaid and publicly funded attendant care services.