Ensuring Due Process Protections in Medicaid Program

Individuals with disabilities are entitled to due process under Medicaid to ensure that services are not terminated or reduced unfairly.  In Dorohovech v. Richman (2007), DRP brought a lawsuit against the Department of Public Welfare after it terminated individuals from a Medicaid Waiver program after it changed the rules barring eligibility for those who live in personal care homes, without providing notice or assistance to find alternative housing to stay in the Waiver.  We were able to negotiate a settlement which required DPW to reach out to all who were terminated and help them, if they wanted, to find alternative housing to stay in the Waiver.

DRP has fought for Medicaid decisions to be issued in a timely fashion.  If an individual disagrees with a reduction, termination, or denial of Medicaid services, they can challenge that decision through processes that are available from the Bureau of Hearings and Appeals (BHA).  In Doe v. Houstoun (1997), DRP filed a successful lawsuit to require the Department of Human Services to comply with the rule to issue final decisions in BHA appeals within 90 days.  In Mosley v. Alexander (2011), DRP filed a successful lawsuit that required DHS to ensure that individuals received decisions about whether they were eligible for Medicaid Waiver programs within 90 days and that the written notices issued to tell individuals about those decisions were clear and fair.

In Schaid v. Mackereth (2013), DRP represented an individual with a disability who wanted to move into the state but needed to have access to Medicaid services as soon as he arrived in the state.  DRP was able to successfully obtain an exception to the rule that you have to establish residency in the state before you can apply for Medicaid, which allowed our client to apply for Medicaid in Pennsylvania prior to his move to our state.