Thousands of disabled Ohioans who had been in limbo waiting for health-care benefits to start are now guaranteed their applications will be reviewed in a more timely matter, according to a recent federal court ruling.
A class action lawsuit filed in March, 2010, in U.S. District Court in Toledo was settled by consent decree this month, concluding a months-long legal battle and a years-long problem, advocates said.
The settlement requires the Ohio Department of Job and Family Services to automatically enroll in Medicaid any individuals whose applications have been pending more than 90 days, and directs the agency to work toward permanently eliminating lengthy waits.
“At the time the case was filed, there were more than 22,000 applications pending with the ODJFS for more than 90 days, with some in excess of one year,” said W. David Koeninger, a lawyer with Toledo-based Advocates for Basic Legal Equality Inc.
He added that the first round of applications should have been processed by now and applicants will be eligible for benefits by Sunday.
“Many of these individuals had severe disabilities, and were not able to obtain necessary medical care while their applications were pending,” he said.
“Many of them suffered unnecessarily because of the state of Ohio’s failure to provide eligibility determinations for Medicaid within 90 days after each application was filed, as required by federal law.”
The lawsuit was filed by ABLE on behalf of the Ability Center of Greater Toledo as well as five northwest Ohio residents.
The complaint alleged that Ohio took too long in reviewing cases and thus caused many people to be denied Medicaid services for unreasonable lengths of time while waiting for decisions on their claims. The lawsuit further alleged that the delays were excessive enough to violate federal mandates and put residents at risk.
The 10-page consent decree was ordered Dec. 2 by Judge James Carr. It keeps the case under the court’s jurisdiction until January, 2014, to ensure the agreement is upheld.
In addition to ordering the state agency to reduce the application backlog — including requiring that by July 1, 90 percent of all applicants are enrolled within 90 days — the settlement calls for the Ohio Department of Job and Family Services to hire an outside vendor to help collect medical documentation needed by the county agencies for processing applications.
This addition is a “major redesign in the disability determination process” that has been sought since 1997, advocates said. The change will mean more help for applicants who needed to collect medical evidence necessary for their claims.
“This is a huge victory for people who are marginalized,” said Tim Harrington, executive director of the Ability Center of Greater Toledo. “It’s really important that folks in Ohio who are poor and disabled have access to health care, and that’s what this does.
“When you have people who don’t have access to health care who desperately need it, that’s just plain wrong,” he said.
Ben Johnson, spokesman for the state agency, said that the Ohio Department of Job and Family Services already has taken several steps to eliminate the backlog problem and so has reduced the number of people waiting to about 5,000 from 22,000 since 2011 started. Hiring the vendor, scheduled to be in place by spring, will further address the underlying problem, he said.
“Once a vendor is in place, the wait time will continue to be reduced,” he said. “Ultimately we will determine disability and process these applications within the 90-days time limit.”
Mr. Johnson noted that a person’s eligibility is under continuous review. If a person is determined not to be disabled, the state has the ability to “disenroll” the individual, he said.
Also as part of the decree, the state must provide monthly and quarterly reports to ABLE documenting numbers of pending applications, numbers of denied applicants, and reasons for the denials.
Mr. Koeninger said the true testament of the settlement’s importance is the health of people who are finally receiving benefits they deserve. Not only are they physically healthier, he said, but many are more upbeat about what’s to come.
“One of the most striking things was how good everybody looked,” he said of the lawsuit’s named plaintiffs who found themselves moved through the process. “They are getting the treatment they needed.”
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