Judge Orders Ohio to Restore Medicaid Benefits to Some But Not All Who Lost Them

by | April 3, 2015 AT 10:00 AM

By Catherine Candisky

A federal court judge ordered Medicaid coverage continued or reinstated to several low-income Ohioans in a lawsuit against the state.

U.S. District Judge Algenon L. Marbley's temporary restraining order issued on Thursday applies only to those who filed suit. He declined a request to reinstate health benefits to thousands of other Medicaid beneficiaries who have been tossed from the rolls during the state's annual redetermination process.

The order comes just days after Legal Aid Society of Columbus filed suit on behalf of five individual Medicaid recipients and dozens of others represented by two groups advocating for the poor.

"This court finds immediacy and irreparability of injury because plaintiffs have presented evidence showing individual plaintiffs' Medicaid benefits, and the Medicaid benefits of the members of the two associational plaintiffs, have been terminated or are at immediate risk of termination as a direct result of procedures that violate federal law governing Medicaid redetermination, and due to termination notices which are in violation of due process," Marbley wrote in his order.

Marbley set a hearing for April 15 on Legal Aid's request for a preliminary injunction. The temporary restraining order remains in effect until then.

"We respect the court's decision and are in the process of complying with the order," said Sam Rossi, spokesman for the Ohio Department of Medicaid.

"We are working closely with the relevant stakeholders, advocates and partners to continue providing the high quality service and efficient value that Ohioans deserve."

The state's Medicaid program provides health benefits to 2.9 million poor Ohioans, including more than 450,000 who became eligible last year under Gov. John Kasich's expansion of eligibility guidelines. Since March 1, more than 61,000 have been removed after failing to submit information required to verify their continued eligibility.

Legal Aid attorney Kathleen C. McGarvey said federal law requires the Ohio Department of Medicaid to conduct annual reviews to see if beneficiaries remain eligible, but state officials failed to follow required guidelines.

For instance, the state failed to give recipients the reason they were losing benefits or notify them of their right to appeal. Officials also never attempted to make "passive" redeterminations with available information in client files nor did they conduct reviews to see if beneficiaries were eligible for other assistance, she said.

Ohio Attorney General Mike DeWine argued that those named in the lawsuit either never lost Medicaid coverage or had their benefits restored before the court action was filed. He also questioned whether those represented by Community Refugee and Immigration Services and Community Development for All People faced loss of Medicaid benefits.

Marbley, however, found all were at risk of losing Medicaid, including those unnamed members of the two advocacy groups.

"This court assumes that by virtue of the fact that a high percentage of CDP's and CRIS's members are Medicaid recipients, at least some of their members recently have been subject to infirm redetermination processes that affect all Medicaid recipients," Marbley wrote.

(c)2015 The Columbus Dispatch (Columbus, Ohio)