Hearings officer berates state Medicaid office

HELENA, Mont. (AP) - The director of the state health department said his office needs to make some improvements after a hearings officer chastised the agency over the handling of a Missoula family’s case.

Missoula electrician Bill Fister said trying to determine and obtain Medicaid benefits for his parents’ dementia care became a “nightmare” that cost him more than $10,000 in legal fees.

Hearings officer Bridgitt Erickson found the Department of Public Health and Human Services‘ actions in the Fister case were “unconscionable.”

“Nobody should have to pay a lawyer simply to understand the department’s Medicaid process,” she wrote in a Jan. 21 decision.

Erickson ruled that Medicaid owes the nursing homes caring for Fister’s parents as much as $8,600, to cover costs incorrectly denied.

She also found the agency used its “frequently dysfunctional” computer system as an excuse for miscalculating the family’s benefits and tried to deceive the family into giving up its right to a hearing.

“It is wrong for anybody to engage in such manipulation, but for public employees … it is unconscionable,” Erickson wrote.

Agency Director Richard Opper said the department will better train staffers on how to handle such cases and make the Medicaid eligibility system more “user-friendly.”

“We didn’t handle this well,” he said. “We’re going to make it right for the family,” Opper told Lee Newspapers of Montana. “I wish I could say we disagreed with the findings here, I wish I could say we were blameless here. We need to improve.”

Fister said he was told the past-due amounts will be paid to the Missoula homes that house his parents, Elsie and Gale Fisher, and that errors in coverage amounts have been corrected. But Fister wanted to make the case public because he suspects his family isn’t the only one that has had difficulty with the Medicaid program.

To qualify for Medicaid coverage of nursing home costs, an elderly Montanan cannot have assets of more than $2,000. Most of their income helps pay the cost of their care. Fister’s 90-year-old mother has been in a nursing home since 2006 and his 83-year-old father has been in a home since 2008.

Fister said the family used his parents’ assets and income, their own money and a $100,000 loan to pay the costs until mid-2012. The parents’ Social Security income also went to the nursing homes, but Medicaid was to pay the rest.

Fister said the family was told his mother was approved for Medicaid coverage in July 2012 and was told their father would be eligible in February 2013.

Fister said he started receiving notices for money the family owed for their mother’s care and were told their father wasn’t eligible for coverage until April 2013. Fister decided to take the case to a hearing.

Shortly before the Oct. 1 hearing in Missoula, Medicaid staffers offered to pay $4,600 to the father’s nursing home if Fister would agree to cancel the hearing. Fister said he determined that money was merely a transfer of money already approved and he refused the offer.

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