Federal Medicaid law requires that Medicaid applications be processed in less than 45 days, or in 90 days for those whom are “aged, blind and disabled.”
In November 2011, more than 55 percent of potential beneficiaries had waited longer than the 45-day time period.
The lawsuit alleges that the prime factor for the delays is the burden of huge caseloads for the state’s Department of Social Services, which has decreased its number of employees by 20 percent during the past decade, during a period when the number of Medicaid beneficiaries has spiked 52 percent statewide.
“Over the last decade, DSS has been systematically stripped of the workers needed to process applications and ensure timely provision of these critically important health care benefits while, at the same time, applications for Medicaid assistance and numbers of Medicaid enrollees have dramatically increased along with worker caseloads,” according to the lawsuit, filed in the U.S. District Court for the District of Connecticut.
The lawsuit also charges that the state attempts to “circumvent” federal timeline requirements by sending out letters asking for additional information from applicants, even when the applicants have sent all the required information.
“These generic letters serve the purpose of presenting a façade of compliance with federal law, by suggesting that the delay beyond the federal law requirement is the applicant’s fault, when in reality the notices are routinely issued in the absence of any missing information from the applicant,” according to the lawsuit.