Sunday, July 8, 2018

Groups that blocked Medicaid plan ask feds to restore related dental, vision cuts; cabinet addresses service-denial claims

By Melissa Patrick
Kentucky Health News

Three advocacy groups have asked the Centers for Medicare and Medicaid Services to reject recent changes to Kentucky's Medicaid program that took dental, vision and non-emergency medical transportation benefits from 460,000 Kentuckians.

In a letter to CMS, the National Health Law Program, a public-interest law firm; the Kentucky Equal Justice Center, and the Southern Poverty Law Center say the state failed to comply with procedural requirements, including an appropriate public-notice period or a 30-day public comment period required by federal law.

The letter also says the state's official request to remove these services, called a state plan amendment (SPA), was never approved, noting that it is not on CMS's online list of approved SPAs, so "We have concluded that CMS has not approved this SPA."

The 460,000 people are covered by the state's 2014 expansion of Medicaid, under the 2010 Patient Protection and Affordable Care Act, to those who earn up to 138 percent of the federal poverty level. Under a state Medicaid plan that was vacated by a federal judge, those covered by the expansion could "earn" dental and vision benefits by participating in certain self-improvement activities, such as passing a GED exam, completing job training, or completing wellness activities such as stop-smoking classes, weight-loss programs or diabetes education. They could also earn credits by working; most on the expansion work.

When U.S. District Judge James Boasberg of Washington, D.C., vacated the state's new overall plan for Medicaid, that left the 460,000 people without a way to earn the benefits. The three groups, which filed the lawsuit, argue in their letter to CMS that the state's denial of benefits violates Boasberg's order because "The court expressly intended to maintain the status quo." The letter urges CMS to "act quickly" to reject these changes," which they say "are causing great confusion and harm."

As an example, the letter says an employee of a Kentucky Medicaid managed-care organization said one of its members had been told they couldn't have a "medically necessary" surgery until some of her teeth were pulled, but her dental benefits had been denied because of the cutback.

Cabinet blames reported denials of service on providers

Deborah Yetter of the Louisville Courier Journal reported "widespread concern and confusion about the cuts," including patients showing up at dental clinics who should have been covered, like children and pregnant women, but were showing up in the state's system as having no coverage. The Kentucky Oral Health Coalition has also reported similar denials to eligible children and pregnant women.

Doug Hogan, a spokesman for the Cabinet for Health and Family Services, told Yetter that it was the Courier Journal and the advocacy groups who were perpetuating confusion, noting that pregnant women and children are exempt from the cuts.  He also blamed health-care providers who "have misinterpreted computer-screen eligibility information and turned away some patients."

Hogan told Kentucky Health News that the office of a Floyd County dentist who had told Yetter he had turned away about 10 children had, it turned out. misread information on a computer screen. "Our records show that the concerns were sent to the cabinet at 12:45 p.m. on Tuesday, and by 2:45 p.m. Tuesday we had confirmed their eligibility for full dental and vision services."

Hogan also wrote, "We have identified examples where providers have misinterpreted computer-screen eligibility information and turned away some patients, despite them having active coverage. To eliminate any further confusion, we have created several documents aimed at educating Medicaid recipients about their benefits and outlining for providers the beneficiaries who have routine vision and dental coverage. Over the last few months, numerous provider trainings were held."

Hogan concluded, "We appreciate everyone’s help in making sure our beneficiaries are receiving the services and support they need. If you think you have been incorrectly identified in a different eligibility group, you can call 800-635-2570 for assistance." Hogan supplied an emendated computer-screen grab as an example of problems and the cabinet's action:
Click on the image to view a larger version
The Kentucky Equal Justice Center has filed an open records request seeking more information on the state plan amendment that was submitted to CMS in April. Hogan said in an e-mail, “We are still reviewing the letter, but we have been in contact with CMS throughout the state plan amendment process going all the way back to April and will continue to work with them through the approval process.”

The vacated plan, called Kentucky HEALTH for "Helping to Engage and Achieve Long Term Health," was set to launch July 1. It included requirements for work, volunteering, job training or drug treatment; monthly reporting; lock-out periods for failure to comply; and small premiums based on income.

On June 29, Boasberg sent the plan back to the U.S. Department of Health and Human Services for review, ruling that Secretary Alex Azar had not fully considered the state's projection that in five years the Medicaid rolls would have 95,000 fewer people with the plan than without it.

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