Suit alleges wrongful Medicaid denials

Share: FacebookTwitterEmail

This graphic is an outline of the shape of Pennylvania with a portion of the state flag inside it.The Disability Rights Network of Pennsylvania filed a class action lawsuit April 18 challenging the state’s handling of its Medicaid home and community-based waiver program for ensuring people with disabilities can live outside of institutions.

The complaint, on behalf of six individuals who were allegedly denied services, details a system where individuals in need are routinely deemed ineligible for arbitrary reasons and are given little opportunity, or information, to appeal eligibility decisions, in violation of the Social Security Act.

“Defendant has refused to allow some individuals with disabilities and chronic disabilities even to apply for (Office of Long Term Living) Waivers, determining after brief interviews that they are not eligible,” according to the complaint, filed in the U.S. District Court for the Eastern District of Pennsylvania. “Others, who are allowed to apply for OLTL Waivers, do not receive from the Defendant timely determinations as to their eligibility, leaving them struggling without necessary personal care and other services they need to live in their own homes and communities.”

The state Department of Public Welfare stated in February 2011 that about 1,700 people with disabilities in the state are awaiting eligibility determinations for the waiver. These determinations are legally required to be made within 90 days.

The state’s Department of Public Welfare’s contractor that oversees the waiver process serves both as an enrollment broker and as a service provider, which the complaint suggests is a conflict of interest that incentives the department to unfairly restrict services.

The lawsuit could affect hundreds, if not thousands, of people with disabilities in the state of Pennsylvania.

Disability Rights Network of Pennsylvania is part of the federally funded protection and advocacy system and a member of the National DisAbility Rights Network.