Complaint Challenges Medicaid Hearing Delays

by Andy Jones
April 11, 2017

Disability Rights of West Virginia filed a complaint in federal court March 17, accusing the state of intentionally delaying Medicaid fair hearing requests during the pendency of a class-action lawsuit challenging its practices concerning Medicaid-funded, long-term services for people with disabilities.

In July 2015, Mountain State Justice filed a lawsuit against the state Department of Health and Human Services, alleging that the state caps the amount of money it spends on each of the recipients in its Intellectual/Developmental Disabilities Home and Community Based Service Waiver Program. This is despite Medicaid requirements that the person’s services be tailored to meet their individual needs.

The U.S. District Court of the Southern District of Virginia issued a preliminary injunction in September.

Under federal Medicaid law, individuals may request a fair hearing when Medicaid benefits are denied, reduced, or terminated, or when a claim for medical assistance “is not acted upon with reasonable promptness,” the complaint states. A hearing and a final administrative decision must be made within 90 days.

In the complaint, Disability Rights of West Virginia alleges that, starting in August, the agency’s Board of Review established a "practice of holding Medicaid fair hearings in abeyance” while the litigation is pending, meaning that fair hearing requests have been placed on hold indefinitely.

The complaint is filed on behalf of two unnamed individuals.

“It is unknown how many other I/DD Waiver Program recipients may have been treated similarly,” the complaint states.

IDRWV asserts that the practice violates both the Fourteenth Amendment’s Due Process Clause and the First Amendment’s right to petition.

“The practices of the BOR caused persons with disabilities, for which DRWV is federally mandated to provide advocacy and representation, to go without hearings and final administrative decisions for a time extending beyond 90 days,” the complaint states. “Furthermore, failure to provide persons with disabilities a final administrative decision within 90 days has and will continue to cause I/DD Waiver recipients to lose waiver benefits needed for long-term maintenance of their integrated living arrangements.”

The full complaint can be read here [PDF].

Disability Rights West Virginia and Disability Rights Washington are the designated protection and advocacy agencies in West Virginia and Washington, respectively, and are members of the National Disability Rights Network.