Citing a severe and chronic backlog, advocacy groups have filed a class-action lawsuit accusing the state of failing low-income and disabled Marylanders by regularly taking nearly a year to approve medical assistance applications.
The lawsuit, filed last week in Baltimore Circuit Court on behalf of nearly 10,000 disabled adults, seeks to force the Department of Human Resources to approve the Medicaid applications within 60 days, as required by state law. The advocates allege that nearly 46 percent of applications in 2012 were illegally delayed.
"As a result of the defendant's failures, low-income and medically-needy individuals with disabilities cannot obtain needed medical care and treatment and face serious, often life-threatening health risks," according to the lawsuit by the Public Justice Center, the Homeless Persons Representation Project and the National Center for Law and Economic Justice.
Marylou Magee-Kern, a 47-year-old Reisterstown woman who lost health insurance when her husband was laid off, is the lead plaintiff in the case. She has waited more than 230 days for the state to approve her application, according to the lawsuit.
As a result, Magee-Kern hasn't been able to get treatment by specialists — except when hospitalized — for kidney failure, diabetes and hypertension, among other ailments.
The case is typical, said Carolyn Johnson of the Homeless Persons Representation Project.
"People with serious medical conditions apply for Medicaid and then wait months, often more than a year, for the state to process their applications and provide benefits," Johnson said in a statement. "During that time, they can't afford to see doctors or afford testing and treatment, including prescriptions and medical supplies."
She added: "So they go without health care until serious conditions deteriorate and become acute or life-threatening, which often means they end up in the emergency room, costing the state far more money."
Theodore Dallas, secretary of the Department of Human Resources, said the agency has been working to improve its process for determining eligibility for the entitlement programs. Dallas said the medical assistance applications are more complex than most other benefit cases, because the federal government requires an assessment of physical and medical disability.
"Because of the nature of the disabilities involved," Dallas said, "applicants may have difficulty pulling together the documentation that is required under federal and state law."
"Still, there is no question that more needs to be done," Dallas said in a statement. "Well in advance of the lawsuit, the department began efforts to improve determinations for these specialized types of Medicaid cases."
Dallas said portions of federal health care reform that become effective in January 2014 will simplify the application process with changes to the documentation requirements.
"Until that welcomed change occurs, the department will continue to execute on its plan to improve this process with or without the presence of a lawsuit," the secretary said.
Dallas said when he arrived on the job in 2011, the Department of Human Resources faced a court order to improve the time it took for evaluating "virtually every type of benefit."
When that case was filed in April 2009, more than 4,000 food stamp requests were delayed, as were 7,000 applications for medical assistance for families. Then in June, a Baltimore judge found the state was meeting deadlines for enrolling Marylanders in Supplemental Nutritional Assistance Program, or SNAP, Temporary Cash Assistance and medical assistance for children and parents.
But advocates said problems persisted in approving applications from disabled adults. Camilla Roberson, an attorney for the Public Justice Center, said low-income disabled adults need the assistance to have access to doctors and prescriptions.
"These numbers represent real people, who are very vulnerable, very sick and need treatment," Roberson said in a statement. "These delays have been going on for years and are getting worse. The consequences are felt by every poor applicant whose health deteriorates each day he or she goes without needed care and by society at large when it pays for emergency room visits and hospitalization, as well as the lost potential for stabilization or recovery."
Magee-Kern first filed her application for medical assistance on May 29. She received two letters from the state, one dated June 28 and one dated July 30, that indicated "an agency delay has occurred."
Magee-Kern received no further communication from the state until Saturday — after the lawsuit was filed. The state now says it is processing her application; she is still waiting to receive benefits.
"You're borrowing off your brother. You're borrowing off your sister-in-law. You're borrowing off your former boss," she said. "It's been a really rough ride."