Arguments set in Medicaid appeal

In a case that involves whether Medicaid applicants who were rejected can include information that was not in their initial applications when they appeal, the Indiana Supreme Court has set oral arguments for March 3 at 9 a.m.

In its July 21 decision in Anne Waltermann Murphy, et al. v. William Curtis, et al., No. 49A04-0909-CV-503, the majority of an Indiana Court of Appeals panel reversed the decision of a Marion Superior judge and found in favor of Anne Waltermann Murphy in her official capacity as secretary of Indiana Family and Social Services Administration and Patricia Casanova in her official capacity as director of the Office of Medicaid Policy and Planning of the Indiana Family and Social Services Administration.

One of the Court of Appeals judges dissented, writing that she disagreed with the majority’s conclusion that an administrative law judge’s “refusal to consider evidence of conditions not disclosed on a Medicaid disability application does not violate federal Medicaid law and the Due Process Clause of the Fourteenth Amendment.”

American Civil Liberties Union of Indiana attorneys who represented the three named plaintiffs – William Curtis, Gary Stewart, and Walter Raines – as well as attorneys for Indiana Legal Services who frequently represent Medicaid applicants in their appeals, have expressed concern that because applicants are unsure of what is needed for successful applications, with or without assistance from a family member or social worker, they should be able to present additional evidence at appeals.

Lawyers in the attorney general’s office who represented Murphy and Casanova argued that in many cases, applicants do have someone who should be able to provide enough information to help with applications.

However, attorneys for the plaintiffs said that while this is sometimes the case, the three plaintiffs’ experiences in a relatively short amount of time led them to believe there were many more examples of failed appeals where the applicants should have been allowed to present more evidence at appeal than what was in the application.

In Curtis’ case, his caseworker advised him only to report his mental health issues and not include his orthopedic problems. Stewart, who applied so he could receive medical attention, which is a fairly common reason to apply for Medicaid, wasn’t diagnosed with his pre-existing condition of congestive heart failure until after he submitted his application. He did not know what was wrong at the time he filled out his application. Raines “either had trouble identifying his illness or he didn’t consider it disabling,” said ACLU of Indiana attorney Gavin Rose, who represents the plaintiffs.

Rehearing "Medicaid applicants facing 'tremendous hurdles'?" IL Sept. 29-Oct. 12, 2010