HARRISBURG, Pa. (AP) — Gov. Tom Corbett's plan to overhaul Pennsylvania's Medicaid program is being mishandled and, in less than 10 days, could create serious medical problems for people who are cut off from crucial health care benefits, lawyers for the poor argued Monday in a court challenge.
The lawsuit, filed in federal court in Philadelphia, seeks to halt the diversion of Medicaid enrollees into new plans with limits designed for healthier adult Medicaid enrollees.
The filing comes ahead of the Jan. 1 effective date for the Corbett administration's plan to restructure benefits in the health care program that currently serves 1.1 million adults. Including the expansion of Medicaid's guidelines under the 2010 federal law, Corbett's plan creates three benefit levels to replace the 14 currently in effect. Each Medicaid enrollee would be sorted into a benefit level based on their relative health and income.
But Community Legal Services of Philadelphia and the National Health Law Program said reductions in benefits designed for working-age, able-bodied adults are being imposed without adequate notice or clear standards, and they asked a federal judge to stop the plan from taking effect until these concerns are addressed.
The complaint was filed on behalf of two Philadelphia residents.
Melissa Mendez, 33, is applying for Medicaid coverage. She was told she would be assigned to a plan that does not include dental benefits, even though she has three broken teeth in need of repair after a fall in October that also fractured her jaw.
The other plaintiff, Aminata Diao, 37, has a history of mental illness, suffers from depression and asthma and is recovering from an injured back. She was assigned to a plan that does not meet her needs even though she seems to qualify for a broader benefits package, Community Legal Services said.
"This is a system that nobody really understands how it works, the standards have not been made public, people got notices they didn't understand, or didn't get notices at all in some cases, and in the process people are going to lose benefits that they really need on January 1," said Kristen Dama, a lawyer for Community Legal Services.
The system violates the Social Security Act and constitutional guarantees of due process, the lawsuit said.
In a statement Monday, the Corbett administration said it disagrees with the lawsuit's allegations and that it would work to avoid confusion or disruption of service. People can be enrolled in a different plan if their medical needs demand it, the Department of Human Services said.
Corbett's administration has touted the changes to Medicaid coverage as a way to simplify the current lineup of plans and save money by better tailoring benefits to the needs of each enrollee. Notices to enrollees went out in November.
Helping the Department of Human Services decide who goes into which program is an enrollee's Medicaid history and a four-page questionnaire that an enrollee can fill out.