Investigation: Medicaid delays, denials - Dallas News | myFOXdfw.com

Investigation: Medicaid delays, denials

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Texas children and the elderly are falling through the cracks when it comes to some lifesaving benefits.

When the Affordable Care Act rolled out, applications for Medicaid soared as millions of people nationwide became eligible for benefits.

Texas claims there is no backlog getting applications processed, but state employees say delays and denials are putting the state’s most vulnerable citizens at risk.

At 77, Joan Mulcahy is all alone. She can’t stand or walk and has no kids or family in Texas. When her husband John died in January, she needed help immediately. 

She cannot get in and out of bed or to the bathroom alone. She qualified for state Medicaid, but getting that help proved to be nearly impossible.

“It makes you feel like you are not worth the time nor the bother,” Mulcahy said. “Dog gone it all, we are senior citizens. We have contributed. I know I have contributed. I know John has contributed, not only to the cities we have lived in, but to the state and to our country.”

Mulcahy signed up for Medicaid in January and her case should have been a top priority. But month after month, nothing. 

Not only was she burning through her only savings trying to pay for help; the care she was got was sporadic at best.

“If someone says, ‘I am not coming this weekend,’ what does that mean to you?” FOX 4’s Becky Oliver asked.

“That means you sit in your chair. You get a blanket,” Mulcahy said. “It is unhealthy, unpleasant, scary.”

Desperate, Mulcahy finally started calling Garland paramedics for help.

“That is what you have to do when you have no one to show up to help you get out of bed,” Mulcahy said.  She told FOX 4 she has had to call paramedics four times in recent months.

“Joan, she should not be in the position she is in at all,” Amera Frieman said.

Frieman is a caseworker with the Texas Health and Human Services, which oversees Medicaid approval.

“Her case should have been completed January 21,” Frieman said.

Frieman says there is a crisis in state government. The cases are piling up because so many people are now eligible for benefits through the Affordable Care Act, and Gov. Rick Perry did not take the expansion money from the feds.

“It has tripled our caseloads, whereas maybe I was assigned 200 cases a month, now it’s at least 350 or more,” Frieman said.

What’s happening is that cases are being delayed or even denied.

“A lot of times, some workers would just go in and just try to clear those cases,” said a former employee who wanted to remain anonymous.

“The caseloads are ridiculous,” she said. “There is no way that you’re gonna be able to pull a caseload of 15 to 20 interviews a day.”

Internal notes show Mulcahy was calling in to check on her application, but the state was apparently doing nothing more than making note of her calls. 

On March 6, it says, “client and spouse are over the income limit.” That was two months after John died. 

After FOX 4 started making calls, Mulcahy was finally authorized for services in late April. 

The state says 60 percent of the cases in Texas are approved within two weeks. But according to these mid-June statistics, there are 97,057 pending cases statewide.

A spokesman from HHS told FOX 4 that Mulcahy’s case was not denied; it was just processed late because it was assigned to a worker who was out on leave.

“This is part of the file to Texas Health and Human Services,” Oliver Reown said, holding a large stack of documents.

Reown went around in circles for months with HHS and his kid’s health insurance.

“Here I am, with three children that are eligible for coverage and cannot get the coverage, and had a sick child during the process,” Reown said.

Reown says he worked for 40 years and contributed to the system, but when he needed help, the state could not deliver.

The state told FOX 4 Reown’s case was actually processed on time, but got caught between the state and the vendor system that assigns the kids to a health plan. 

After FOX 4 contacted the state, the approval sailed through.

“After trying for months, within a week, I get some results,” Reown said. “And I’m grateful. I’m grateful.”

Back in Garland, Mulcahy’s problems are just getting more complicated. Now, her home health agency is taking legal action against her, saying she owes them more than $3,000 for the services she got while she was waiting on the state. 

Mulcahy lives on $750 a month.

“It’s a disgrace, an absolute disgrace,” Mulcahy said. “It really is.”

The state says it is now investigating Mulcahy’s case to see why it took so long for Mulcahy to get services, even though she had two outside state caseworkers assigned to her.

Mulcahy believes she shouldn’t have to pay the price for the state’s delays.

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