| A Charleston public interest law firm plans to file a lawsuit against the West Virginia Medicaid office, alleging that the agency's revamped government-funded health insurance program penalizes poor children
By Eric Eyre
Staff writer
wvgazette.com
CHARLESTON, W.Va. - A Charleston public interest law firm plans to file a lawsuit against the West Virginia Medicaid office, alleging that the agency's revamped government-funded health insurance program penalizes poor children.
Mountain State Justice says the state Medicaid office has repeatedly violated federal law and subjected families to a confusing benefits package that limits services to kids.
The law group plans to file the suit on behalf of two Medicaid-covered children, according to a letter sent earlier this month to the state Department of Health and Human Resources. The letter notified the department of Mountain State Justice's intent to sue sometime after 30 days.
"The Medicaid redesign is being administered in a way that's failing to provide children with essential health care as required by federal law," said Bren Pomponio, a lawyer with Mountain State Justice.
A Medicaid spokeswoman said Monday the agency doesn't comment on pending litigation.
However, the Medicaid office continues to defend the revamped program, which allows recipients to sign "personal responsibility" agreements to improve their children's' health in exchange for expanded benefits.
"Nobody's being denied medically necessary services," said Shannon Landrum, legislative liaison for West Virginia Medicaid.
Medicaid provides health care coverage to about 30 percent of all children in the state.
Last August, two organizations - Georgetown University's Center for Children and Families, and a health care consumer group called Families USA - issued separate reports that sharply criticized West Virginia's redesigned Medicaid program. Both groups alleged the program - called "Mountain Health Choices" - was failing the state's poorest children.
More than 90 percent of West Virginia children with Medicaid - including newborns - have had their health benefits restricted since the program changed two years ago, according to the Georgetown study.
Both groups cited widespread confusion among families and doctors about the changes.
Only about 12 percent of parents with children on Medicaid statewide have enrolled their kids in the revamped benefits package, known as the "enhanced plan." That plan was designed to entice low-income people to see a doctor regularly, keep appointments and stay out of hospital emergency rooms.
Most children are winding up with the state's scaled back "basic" package that has fewer benefits than traditional Medicaid. Children are automatically put in the basic plan, if their parents don't sign the personal responsibility agreements under the enhanced plans.
The basic plan limits kids to four prescriptions a month. Mental health services also are restricted.
"If parents don't fill out [personal responsibility agreements], kids aren't being provided comprehensive services," Pomponio said.
Landrum said West Virginia University researchers have started a study to evaluate the revamped Medicaid program, which won't be fully up and running 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."
Reach Eric Eyre at erice...@wvgazette.com or 304-348-4869.
wvgazette.com
| 
