COLORADO
BENEFITS MANAGEMENT SYSTEM
COLORADO
BENEFITS MANAGEMENT SYSTEM:
COLORADO
BENEFITS MANAGEMENT SYSTEM
Judge Coughlin Issues Ruling in CBMS Case.
In December 2004, Judge John Coughlin issued his decision in the
CBMS case (attached). It represents a substantial victory for the plaintiffs.
Main points of the decision include:
- Ordering the State to reduce the number of cases outside of timely
processing (45 days for most Medicaid and CHP+) by 40% by 2/28/05 and another
40% each 60 days thereafter until the State is meeting federal guidelines for
timely processing.
- Ordering the State to create an emergency processing unit with an
adequately staffed 1-800 number to handle cases that are out of timely
processing; cases where eligible families have had their benefits delayed or
terminated erroneously; and cases where the family is facing an extreme
emergency such as imminent hunger or loss of housing. This emergency unit is
ordered to resolve such cases within 5 days and needs to be established by
12/31/04.
- Ordering the State to fix the issues with incorrect noticing by 2/28/05.
- Ordering the State to keep the Benefits Freeze Flag in place until the
court determines it is time to take it off (this is a very technical issue but
I know those of you in the counties will appreciate it--please let me know if
you have questions about this one).
On Aug. 30, 2004, CCLP lawyers joined with lawyers
in private practice in Denver and the Welfare Law Center in NY to sue
to delay or perfect the implementation of Colorado's Benefits
Management System (CBMS). CBMS is a large scale computer system
designed to integrate public benefits processing in several program
areas, including Food Stamps, TANF (Colorado Works), Medicaid.
Colorado's Old Age Pension, Aid to the Needy Disabled, and others. The
Denver District Court initially granted an injunction prohibiting the
State from requiring applicants from signing documents which were made
to contain false information to help the computer system operate. In
September, he denied plaintiffs request to shut the system down and
revert for a period to pre-existing systems while the new CBMS
is improved. The case is ongoing, with CCLP lawyers Elisabeth
Arenales, Maureen Farrell, and Ed Kahn representing benefits
recipients and applicants whose cases have been delayed or mishandled
by the system. Denver lawyer Michael Cook of Sherman & Howard is
plaintiffs' lead counsel. CCLP has received substantial factual
assistance from agencies serving the poor throughout the State.
Defendants are the State Directors of Human Services and Health Care
Policy and Finance. Hawthorne-Bey v. Reinertson, D Dist Ct, 04 CV
7059.
Reductions in Medicaid Non-Emergency
Transportation Services
The Medicaid program is required
to ensure that Medicaid participants can get back and forth to Medicaid
covered services. During the 2003 Colorado Legislative Session,
lawmakers reduced Colorado’s Medicaid transportation budget by
approximately two-thirds (a decrease of $7.6 million). In order to
implement this budget cut, the Colorado Medical Services Board adopted
rules that deny those Medicaid participants who do not need a
specialized form of medical transportation access to Medicaid
transportation services. Those rules took effect July 1, 2003.
Probably the largest impact of
this new rule was on those participants who went without medical care
because they were unable to afford transportation to get to a doctor’s
office. Medicaid is, of course, designed to serve very low income
people. The majority of those on Medicaid in Colorado are children who
qualify only if their family income is less than 100% of the federal
poverty level ($18,400 annual income for a family of four) and do not
have a car worth more than $1500.
Many disabled adults in the program have incomes of only about $589 a
month. People who live in rural areas were also impacted, particularly
those who had to travel to Denver or a metropolitan area for specialty
care. Even for people who qualified under the new regulations, the
process has proven to be extraordinarily cumbersome for doctors and
participants – so cumbersome, in fact, that it has resulted in denial of
care even for those who should still qualify for transportation services
under the new rule.
Colorado Legal Services (“CLS”)
filed a Complaint in Denver District Court in August 2003. Erskine
v. Department of Health Care Policy and Financing challenges the new
transportation regulations on behalf of two children who became
ineligible for transportation services under the regulations that took
effect on July 2003. The Complaint seeks to have the regulation vacated
and asks that a regulation that complies with federal law be adopted.
California and Rhode Island Courts have invalidated similar Medicaid
transportation restrictions. Bingham v. Obledo 195 Cal Rptr. 142
(1983); Conti v. Ferguson C.A. No. 99-5109, R.I. Superior Ct.
(2001). A Motion for Summary Judgment was filed and has now been fully
briefed. CCLP testified in opposition to the rule before the Medical
Services Board and is assisting CLS with this case.
The Centers for Medicare and
Medicaid Services (“CMS”) did approve Colorado’s State Plan Amendment in
January 2004, but required as a condition of approval that Colorado
“assure” transportation services. Amended rules were approved on an
emergency basis by the Colorado Medical Services Board on March 12,
2004. Those rules added back in mileage reimbursement and bus tokens and
passes. (Rule at:
http://www.chcpf.state.co.us/HCPF/msb/attachments/04-02-19-Aapril%20final.pdf
and Agency Letter at:
http://www.chcpf.state.co.us/HCPF/refmat/AL04-006.html)
CLS and the Center on Law and
Policy testified that this change was not sufficient to comply with the
federal requirement to assure that those on Medicaid can get back and
forth to Medicaid covered services. People, particularly those in
rural areas, who are unable to drive or have an unreliable vehicle or
where there is no public transit system will still not be able to get to
care.
There is also a bill that has
now passed the Colorado Legislature (HB-4-1220) that changes Colorado’s
Medicaid non-emergency transportation program from an optional service
to an administrative program. The Colorado Department of Health Care
Policy and Financing’s position is that this change in law will provide
them with more flexibility to tailor the program to meet the needs of
people in various parts of the state. There will be additional rule
changes to implement this change in the law within the next few months.
If you or anyone you know is
having difficulty accessing Medicaid covered services because you cannot
get back and forth to care, please contact: Elisabeth Arenales at (303)
573-5669 x 302.
For full text of Denver Post
article, click here.
