West Virginia Medicaid Program Sued For Reducing Benefits For 90% Of Children Enrolled

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Pediatrics / Children's Health;  Litigation / Medical Malpractice
Article Date: 19 Dec 2008 - 5:00 PST

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Mountain State Justice -- a public interest law firm based in Charleston, W.Va. -- is planning to file a lawsuit against the state's Medicaid office, alleging it has violated federal law by reducing benefits for children whose parents do not sign a "personal responsibility" statement that allows them to receive enhanced benefits, the Charleston Gazette reports.

Under the revamped program, known as Mountain Health Choices, children enrolled in Medicaid can receive expanded benefits as long as their parents sign the pledge stating they will make efforts to improve their children's health. The enhanced plan is intended to encourage beneficiaries to see a physician regularly, keep appointments and avoid using emergency departments in exchange for better Medicaid benefits. Children whose parents fail to sign this pledge are automatically enrolled in a "basic" plan that provides fewer benefits than traditional Medicaid. Ninety percent of West Virginia children enrolled in Medicaid have had their benefits reduced because their parents have not signed the pledge. Two studies have noted "widespread confusion among families and doctors about the changes," the Gazette reports.

MSJ lawyer Bren Pomponio said, "The Medicaid redesign is being administered in a way that's failing to provide children with essential health care as required by federal law." He added, "If parents don't fill out (personal responsibility agreements), kids aren't being provided comprehensive services." According to a letter sent to the state Department of Health and Human Resources earlier this month, the firm will file the suit on behalf of two children who are enrolled in Medicaid.

Shannon Landrum, legislative liaison for the state Medicaid program, said, "Nobody's being denied medically necessary services." She said West Virginia University researchers have started a study to evaluate the program, but the study will not be fully functional until next year. "When the results of that scientifically based study are available, we'll be using that to adjust our program, if need be," Landrum said. "If our individual members experience problems, they should not hesitate to contact our department," she added (Eyre, Charleston Gazette, 12/16).

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