State officials sued over Medicaid benefits

Thursday, Nov. 13, 1997 | 9:16 a.m.

The lawsuit filed in U.S. District Court, Las Vegas, names state Human Resources Director Charlotte Crawford; Welfare Administrator Myla Florence; and Chris Thompson, administrator of the Division of Health Care Financing and Policy.

According to the complaint, the state has failed to provide individualized assessments for certain service requests to determine whether the services are medically necessary.

Instead, the lawsuit charges, the defendants arbitrarily have excluded entire classes of medical equipment, such as certain mobility aids, from coverage.

"Defendants delay for an unreasonable period of time the decision on a payment preauthorization request, without which the Medicaid recipient cannot obtain the needed service or device," the complaint said.

According to the lawsuit, federal law requires Medicaid services be provided to eligible recipients "without any delay caused by the administrative procedures of the state agency" responsible for administering the program.

The complaint also accused the defendants of failing to provide adequate and timely notice to Medicaid recipients of the right to a fair hearing appeal of any denial of a payment preauthorization request, or regarding the delay in receiving services or benefits.

In addition, the lawsuit accused the defendants of failing to grant fair hearing appeals when requested.

The advocacy group, which also represents people stuck on waiting lists for state-subsidized mental health care, warned lawmakers earlier this year that it might sue because of the delays.

Spokesman Travis Wall wrote a joint Senate Finance-Assembly Ways and Means subcommittee to say Medicaid services must be made available promptly.

Wall also cited a recent successful lawsuit in Florida filed for 1,700 people who demanded care. The court found that federal law requires Medicaid services for eligible people and ordered the state to meet the demands.