A Brickeys woman sued the Arkansas Department of Human Services on Friday, saying she has been waiting more than 10 months for word on whether she's eligible for coverage under Arkansas' expanded Medicaid program.
Anita Walker, 53, said in the suit, filed in U.S. District Court in Little Rock, that she applied for coverage through the federal healthcare.gov website on Nov. 24, 2014, and Jan. 21.
The Human Services Department said it never received any information on the application, and it denied her request for a hearing on the issue, saying she would need to appeal through the federal Centers for Medicare and Medicaid Services.
Kevin De Liban, an attorney with Jonesboro-based Legal Aid of Arkansas, said it's the Human Services Department's responsibility to get the information on her application from the federal agency.
Walker could file an application directly with the Human Services Department, but that could mean waiting months longer for word on her eligibility, he said.
He noted that, as of Aug. 2, as many as 31,400 applicants had been waiting for more than 45 days for word on their eligibility.
Federal rules require the state's Medicaid program to determine eligibility within 45 days of an application being made.
If Walker applied with the Human Services Department, "she's going to end up going to the back of the 31,400 people who are already waiting," said De Liban, who filed the lawsuit on behalf of Walker.
A new application would also mean forgoing reimbursement for some medical expenses, including the $40 per month Walker spends on prescription drugs.
Medicaid rules allow an applicant to receive reimbursement for expenses incurred up to 90 days before the date of their application.
"If she were to apply today, she loses all that back coverage," De Liban said.
Human Services Department spokesman Amy Webb said the department, along with its counterparts in other states, has had widespread problems receiving information on applications submitted through the federal website.
She said the department recommends that applicants who think they are eligible for Medicaid apply through a state website, access.arkansas.gov.
"We can't act on any information that we don't have on our system," Webb said.
If the Centers for Medicare and Medicaid Services "did not send us information on people, or sent us incorrect information or unusable information, we cannot act on it," she said.
The lawsuit, assigned to Judge Kristine Baker, seeks orders compelling the department to gather information from the Centers for Medicare and Medicaid Services, determine Walker's eligibility and to pay her legal expenses.
The department has blamed the backlog of applications on a lack of functionality in its computerized enrollment and eligibility system, which has led to many Medicaid applications being processed manually.
The backlog of applications should be reduced, Webb said last month, as more newly hired caseworkers are trained and the department continues to make improvements to the enrollment system, which has been under construction since 2013.
The expansion of the state's Medicaid program extended eligibility to adults with incomes of up to 138 percent of the poverty level: $16,242 for an individual, for instance, or $21,983 for a two-person household.
Walker, who lives with her husband and grown daughter, said in a statement included with the lawsuit filing that she earns $18,000 a year working as a personal care aide.
Her husband is unemployed, and her daughter, who has Down syndrome, receives $721 a month in Supplemental Security Income payments.
She said she listed herself and her husband as part of her household on her application.
Walker takes medicine for diabetes and high blood pressure and visits a community health center clinic, which charges patients on a sliding scale according to income, about once every three months, paying about $35 out of her pocket each time.
She said she has severe pain in both shoulders, which she has been told is likely due to arthritis, but can't afford to pay $900 for an MRI scan to confirm the source of the pain and have it treated.
After she submitted her first application through healthcare.gov, she said she received a notice saying she "may be eligible for Medicaid" and that she should receive more information from the Human Services Department.
In January, she said she called the department and was told it couldn't find her application, so she submitted another application.
She said she called three times to check on that application but "did not receive any useful information."
"I was told that DHS receives thousands of applications and that processing them takes a long time," Walker said in the statement.
With the help of Legal Aid, she requested a hearing on why the department had not acted on her application within 45 days.
Latisha Meadows, an administrative review officer with the Human Services Department, wrote that the department didn't have enough information to act on her application and that Walker should file an appeal with the Centers for Medicare and Medicaid Services.
De Liban said that, under federal rules, only the Human Services Department has the authority hold hearings on the timely processing of applications.
One of his clients filed an appeal with the Centers for Medicare and Medicaid Services on a similar processing delay, and the appeal was dismissed because it wasn't filed within 90 days of the application, he said.
Metro on 10/10/2015
Print Headline: Woman sues to get her Medicaid eligibility status reviewed