Adoian v. Hayward

No. 04-3764 (R.I. Super. Ct. Providence County May 11, 2005) ; Clearinghouse Number: 55919

Description

Rhode Island Department of Human Services Must Comply with Medicaid Act in Conducting Disability Reviews for Disabled Medical Assistance Recipients

Abstract

The parties entered a consent order which requires defendant Rhode Island Department of Human Services to send, before performing a continuing disability review, written notice to medical assistance recipients. Plaintiff disabled adult receiving medical assistance alleged that defendant unlawfully cut off his medical assistance benefits. Plaintiff asserted that defendant’s policies and practices concerning periodic redeterminations of disability resulted in systematic and unlawful benefit terminations in noncompliance with the Medicaid Act, 42 U.S.C. § 1396. Now department must advise recipients that it will be reviewing their disability status and must explain why; that federal medical improvement standard applies; that recipients have the right to submit medical and other evidence for review; and that the review might terminate medical assistance. Department must reasonably obtain recipient’s medical history for at least the preceding twelve months. Department must not terminate a recipient’s medical assistance for lack of disability until it completes the review and determines that recipient has medically improved or that, under the 20 CFR § 416.994(b)(3) or (4) standards, an exception to medical improvement applies. The order states that the burden of proving medical improvement is on department and that department shall not terminate a recipient’s medical assistance because of evidence insufficient to determine disability or because department has not received reports from medical providers.

Additional Information

Attorney Information
Plaintiff represented by Gretchen Bath, Monica Texeira de Sousa, Rhode Island Legal Services, 56 Pine St., Providence, RI 02903 (401.274.2652).
Docket Date
2005-05-11 00:00:00+00:00

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