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From Health Law Daily, May 13, 2015

Ohioans rejoice: Medicaid benefits reinstated for up to 180,000

By Kayla R. Bryant, J.D.

The Ohio Department of Medicaid (ODM) has reached a settlement agreement following a suit brought Medicaid beneficiaries and non-profit organizations regarding improper procedures in Medicaid eligibility redeterminations. This agreement will allow the restoration of lost benefits for between 150,000 and 180,000 former Ohio Medicaid recipients. ODM is also required to make several improvements to its renewal process to come into compliance with federal law (Homewood settlement agreement, May 12, 2015).

Lawsuit. Beneficiaries and two-nonprofits, Community Development for all People (CDP) and Community Refugee and Immigration Services, Inc. (CRIS), brought suit against ODM over benefits terminated due to ODM’s allegedly improper redetermination processes. ODM failed to implement a required passive redetermination process, in which it uses information from other sources to confirm continued eligibility, and review eligibility for other Medicaid categories when a beneficiary is deemed ineligible for one type of Medicaid. Prior to reaching settlement, ODM was enjoined from terminating CDP and CRIS members’ coverage until it instituted the proper procedures (see No termination without redetermination, improper procedures faulted, April 6, 2015).

Settlement. As part of the settlement agreement, those beneficiaries who lost coverage between January 1, 2015, and March 31, 2015, due to failure to respond to the renewal packet will have coverage reinstated by August 1, 2015 via rescinded prior terminations. This will result in no coverage gap for these beneficiaries. The members of CRIS and CDP whose coverage was terminated for this same reason will also have coverage reinstated by this date. The benefits of individual plaintiffs named in the case have already been reinstated.

ODM will conduct the required passive renewal process for coverage renewals according to regulations. A good faith effort to obtain information from available sources for this process is required, as well as notices sent to individuals determined to have continuing eligibility. Those not able to be found eligible through this passive process will receive a renewal packet. Those not eligible for their current category will be notified of the reasons for termination, as well as hearing rights and the effect of re-applying for Medicaid. ODM will continue in discussions regarding the improvement of the renewal process, notices, and renewal packet.

The Legal Aid Society of Columbus noted that those whose coverage will be reinstated can expect notification via letter by early June. Those who do not want to wait for the letter regarding reinstatement of coverage can contact the local County Department of Job and Family Services to request reinstatement.

Companies: Community Development for all People; Community Refugee and Immigration Services, Inc.; Legal Aid Society of Columbus

MainStory: TopStory EligibilityNews MedicaidPaymentNews

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