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Issue Alert - Termination of PlanFirst! Medicaid Benefits

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Date:

Mar 13, 2015

Program Area:

Medicaid

Issue Summary:

On October 29, 2014, a federal court preliminary enjoined the Michigan Department of Human Services (DHS) and the Michigan Department of Community Health (DCH) from terminating the Plan First! Medicaid benefits of tens of thousands of low-income women without first conducting ex parte case reviews to determine if these women are eligible for comprehensive Medicaid. The federal court also ordered DHS and DCH to provide these women with written notice of their eligibility for comprehensive Medicaid following these ex parte reviews.

Persons Affected:

Women who received a notice dated June 7, 2014 stating that (1) “You are receiving this notice because you are enrolled in the Plan First! family planning program. This program will end June 30, 2014,” and (2) that effective July 1, 2014, their health coverage would be denied, closed, or approved with a deductible.

For More Information:

Katie Linehan Staff Attorney Center for Civil Justice 436 S. Saginaw Street, 4th Floor Flint, MI 48502 810.244.8044 klinehan@ccj-mi.org


Background

The Plan First! Medicaid program provided “family planning” health care benefits to those women who were 19-44 years old and had income at or below 185% of the federal poverty level (FPL).  On April 1, 2014, Michigan began offering a comprehensive Medicaid program called the Healthy Michigan Plan for all adults between the ages of 19-64 who had income at or below 138%[1] FPL.  As DHS and DCH expected the majority of women enrolled in Plan First! would be eligible for the Healthy Michigan Plan, the agencies planned to end the Plan First! program effective July 1, 2014.

In a “Health Care Coverage Determination” notice dated June 7, 2014, Plan First! recipients were informed that they were receiving the notice because they were enrolled in the Plan First! program and that this program would end on June 30, 2014.  This notice further stated that the ending of the Plan First! program “affects every woman in the program” and “does not require a fair hearing for this change.”  This notice also either provided “Denial / Closure Information”  indicating that the woman was not eligible for Medicaid because she was not “under 21, pregnant, or a caretaker of a minor child . . . or over the age of 65, blind, or disabled,” or “Approval Information” indicating that the woman was eligible for a monthly deductible beginning “07/01/2014 – Ongoing.”  Many of the women who received these Medicaid denial notices, however, were under 21, a parent of minor children, or a member of another group listed.  Further, many of the women who received these denial notices or deductible notices were in fact eligible for the new comprehensive Medicaid program – the Healthy Michigan Plan. 

On June 23, 2014, the Center for Civil Justice filed a lawsuit (Dozier v. Haveman) on behalf of three low-income women, who sought to represent a class of women, against DCH and DHS.  This lawsuit alleged that DCH and DHS violated federal laws by not reviewing all Plan First! recipients for all categories of Medicaid, including the new Healthy Michigan Plan, prior to terminating their Plan First! Medicaid benefits.  This class action lawsuit further alleged that the June 7 notices, which all Plan First! recipients received, were constitutionally inadequate and failed to provide information required by federal statutes and regulations.  On June 30, 2014 (the day on which the Plan First! program was scheduled to end), DCH and DHS reached an agreement with the Center for Civil Justice to continue providing all Plan First! recipients with family planning benefits pending a ruling on the plaintiffs’ motions for class certification and a preliminary injunction.

On October 29, 2014, a federal court in Detroit granted the plaintiffs’ motions for class certification and a preliminary injunction.  The federal court certified the class as including:

 “[a]ll individuals to whom the Michigan Department of Human Services or the Michigan Department of Community Health sent a notice dated June 7, 2014, stating, (1) “You are receiving this notice because you are enrolled in the Plan First! family planning program.  This program will end June 30, 2014” and (2) that, effective July 1, 2014, health coverage would be denied, closed, or approved with a deductible.”

The federal court also preliminary enjoined DCH and DHS from terminating any class member’s Plan First! benefits until the agencies had performed an ex parte review of a class member’s Medicaid eligibility – specifically for the Healthy Michigan Plan – and provided class members with constitutionally adequate notice.  Specifically, the notice must:

1.    Explain to the class member that the Plan First! program ended on June 30, 2014 and benefits under that program have only been temporarily restored via this litigation and will expire when the class member is placed in a new Medicaid eligibility category, is determined ineligible for any other Medicaid eligibility category, or [the federal court’s] injunction is lifted;

2.    Inform the member that the Departments have performed an ex parte review of the member’s eligibility for the Healthy Michigan Plan based on all information reasonably available to the Departments;

3.    Provide a member-specific reason (e.g., Modified Adjusted Gross Income too high) for why the member was not found eligible for Healthy Michigan or else state that the member is eligible for Healthy Michigan; and

Unambiguously state that the member has a right to challenge the eligibility determination through an administrative process which includes the right to an administrative hearing.



[1] This percentage includes the 5% across-the-board Medicaid disregard.

What's Happening?

Plan First! recipients who received the June 7 notice described above should continue to receive family planning benefits until DCH and DHS perform an ex parte review and determine their eligibility for comprehensive Medicaid.  If a Plan First! recipient receives a request for additional information necessary to conduct these ex parte reviews, the Plan First! recipient should respond to this request by the deadline listed in the request.  There currently is no deadline for DCH and DHS to perform these ex parte reviews, although the Plan First! waiver approved by the Centers for Medicare and Medicaid Services (CMS) is currently scheduled to expire on June 30, 2015.

What Should Advocates Do?

1.    Encourage Plan First! recipients to immediately contact Katie Linehan at the Center for Civil Justice (810-244-8044).

2.    Ensure that Plan First! recipients continue to receive family planning benefits until DCH and DHS have completed an ex parte review of the Plan First! recipients file to determine the recipient’s eligibility for comprehensive Medicaid.

If a Plan First! recipient is determined ineligible for comprehensive Medicaid, ensure the notice informing the recipient of their Medicaid ineligibility complies with court-ordered notice requirements detailed above.

What Should Clients Do?

If a Plan First! recipient is eligible for comprehensive Medicaid, encourage the recipient to apply for comprehensive Medicaid immediately.  Local navigators that can help Plan First! recipients apply for comprehensive Medicaid can be found through the Enroll Michigan website:  http://enrollmichigan.com/.

Finding Help

If you are a Plan First! recipient or know a Plan First! recipient, please have them call Katie Linehan at the Center for Civil Justice at 810-244-8044.

 
Most legal aid and legal services offices handle these types of cases, and they do not charge a fee. You can locate various sources of legal and related services, including the free legal aid office that serves your county, at MichiganLegalAid.org. You can also look in the yellow pages under "attorneys" or call the toll-free lawyer referral number, (800) 968-0738.
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