Alan Bavley | Gregg Lombardi would like to lose this line of work

For the past seven years, Gregg Lombardi and his staff at Legal Aid of Western Missouri have been successfully battling the state’s bureaucracy on behalf of seriously disabled adults who need medical care but are turned down by Medicaid.

Their appeals have added more than 1,000 people to the state’s Medicaid roll. Medicaid payments for their care have brought more than $11 million to Truman Medical Center and other area hospitals. That’s money these poor patients couldn’t have paid.

Without Medicaid, they wouldn’t have gotten care, or their bills would have been written off and the costs shifted to paying patients.

But Lombardi, director of the nonprofit Legal Aid, would be happy to see his Medicaid appeals program disappear, along with the state machinery needed to review these cases.

It’s possible that could happen. Maybe.

As in most states, adults in Missouri who are under age 65 or who don’t have young children aren’t eligible for Medicaid. Permanently disabled people who can’t work are an exception. But Medicaid disability applicants are constantly being rejected, often in error, Lombardi said.

In 2005, Legal Aid started the appeals program at Truman with a $150,000 grant from the Health Care Foundation of Greater Kansas City. It won almost all of its first 200 appeals and brought the hospital enough new revenue to make the program self-supporting.

Legal Aid appealed successfully for a construction worker diagnosed with throat cancer. Medicaid initially ruled he could still work.

A woman with a brain aneurysm needing surgery also initially was judged not disabled.

“She was just going to walk around with this aneurysm until it burst and killed her,” Lombardi said.

Lombardi doesn’t blame the state for unfairly locking people out of coverage. The doctors who turn down applicants don’t always have full medical records. In the case of mentally ill clients, there often isn’t much of a record to begin with.

So Lombardi’s staff goes to hospitals collecting the paperwork. The mentally ill are brought to eligibility hearings. Their testimony often is enough to persuade the judge.

What would make such appeals unnecessary is a provision in Obamacare to expand Medicaid so all adults with incomes below 133 percent of the poverty level would be eligible for coverage. That includes most of Lombardi’s clients.

“All that vast bureaucracy would go away and the money could be spent on medical care,” Lombardi said. “Even though we’d lose a big block of our business, I think that’s fantastic news.”

But this past summer the Supreme Court made Medicaid expansion optional for each state. So far, Missouri Gov. Jay Nixon hasn’t committed on the issue. Kansas Gov. Sam Brownback is waiting for the results of the November election.

The needy may not get medical care, but lawyers and bureaucrats will still have jobs.