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Article by
Leann Holt
Appeared in The Albuquerque Journal
Monday, August 21, 2006
Kids Lose
Medicaid to Paperwork Lag
by Leann Holt
Advocates claim thousands of
children have been dropped from state Medicaid coverage because overworked
caseworkers aren't processing the paperwork before a computer system
automatically terminates the recipients.
The result is children who are eligible for the program who go without
medication or who have their care interrupted.
State records show Medicaid rolls dropped almost 20,000 children between May
2004 and March 2006. The drop comes at a time when Gov. Bill Richardson has
promised to expand health coverage to New Mexico children.
Children's advocates blame the problem on changes the state Human Services
Department made in May 2004 when computers were programmed to automatically
throw cases out of the system if Medicaid eligibility wasn't re-certified every
six months.
But re-certification paperwork piled up on the desks of caseworkers until after
the six-month deadline had passed, advocates and parents say.
The Center on Law and Poverty has
sued the department, contending the automatic disenrollments are illegal.
The federal government requires recertification for recipients but does not
mandate the automatic disenrollment.
As of last month, the automatic termination period was changed to every 12
months.
Kim Posich, executive director for the New Mexico Center on Law and Poverty,
said about 10,000 Medicaid cases a month were dropped between May 2004 and
February 2006, when records became unavailable to them.
Between 75 percent and 80 percent of those disenrolled are eligible for Medicaid
and reinstated one to five months later.
The lapse not only means that children go without medication or treatment but
that they are often assigned to a new doctor when they get back on the rolls,
said Lynne Uhring, president of the New Mexico Pediatric Society.
"We're trying to be their doctor for years, but how can you do that if they keep
getting knocked off?" Uhring said.
Betina Gonzales McCracken, spokeswoman for the Human Services Department, said
that, because of a pending lawsuit, she couldn't comment on claims that
recipients are being dropped even after turning in their paperwork.
But she said the department has requested money for more caseworkers and is
working to fill vacant positions.
Uhring said most parents who come to her office are shocked to find they've been
kicked off the rolls, saying they've done everything they were told to do.
Gonzales McCracken said Medicaid recipients are notified when they are close to
being terminated. |
"It takes personal responsibility
on people's part to get paperwork in," she said. "It would be inappropriate to
allow individuals to remain on the rolls indefinitely without proving they are
residents and are below required income levels."
Health policy consultant Ellen Pinnes said the system has been flawed.
"Caseworkers are not looking at the case and making a decision that you are
ineligible," she said. "They're letting the computer shut you off at a certain
date."
Frustration
Bianca Sivan, a Santa Fe resident, said trying to keep her two children on the
Medicaid rolls has been a nightmare, even though she has consistently submitted
recertification paperwork on time.
Sivan said she has spent hours in welfare offices begging for someone to get her
back in the system after she was automatically disenrolled.
Because of the gaps in coverage, Sivan can't always get medication her son needs
to treat a bowel disorder.
Gonzales McCracken said Medicaid recipients are welcome to call the office of
the Human Services Department secretary if they are having trouble with the
Medicaid system.
State officials say they are simply trying to keep ineligible people off the
welfare roles.
"We want to do the right thing for taxpayers and still keep the people on that
deserve to be on," McCracken Gonzales said.
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