On Monday, Legal Aid of Western Missouri learned that one of its clients — a woman who has suffered from a seizure disorder for 15 years — could keep the Medicaid disability benefits that the state had wanted to discontinue.
It was what has become an increasingly rare victory for Missouri’s aged, blind or disabled who contest the denial or re-evaluation of their benefits through the state-run program.
In 2017, 54 percent of the more than 1,145 people were successful in reversing a denial or re-evaluation of benefits by the Missouri Department of Social Services (DSS), according to data supplied to Legal Aid by DSS. In 2018, the percentage of those who won dipped to 42 percent.
In the first four months of this year, the number dropped to less than 20 percent.
Before Monday, the last time Legal Aid of Western Missouri was able to win back Medicaid disability benefits for a client was five months ago, in April.
A Kansas City-area woman, whose medical benefits were initially denied, had to conduct a telephone hearing from the hospital, according to Jim Brightman, a Legal Aid attorney. The middle-aged woman was hooked up to a colostomy bag and that morning had been transferred out of the intensive care unit.
Brightman is intimately familiar with DSS’s process in evaluating disability cases. Before he joined Legal Aid, he was a DSS hearing officer for more than two decades.
“We are all experiencing the same thing -- it’s virtually impossible to win a disability case at this time,” Brightman said.
Even appealing the DSS’s hearing decision to a judge has become an ordeal, Brightman said. Once notified of an appeal, DSS is required to provide a hearing transcript and exhibits to the circuit court for an appellant to get a docket number.
Just getting a case number, let alone a hearing before a judge, has taken more than a year for most of Legal Aid’s clients, according to Brightman.
“Where’s your due process if you have to wait over a year to have your case reviewed in circuit court?” he asked.
The department did not respond to emailed questions asking for explanations, nor a request for comment.
The problems described by Legal Aid are not on the same scale as the recent drop in state Medicaid rolls. In the last year, more than 130,000 people, 100,000 of them children, have fallen from the program that provides health insurance for low-income families.
While the issue doesn’t affect as many people, those it does touch are among the state’s most vulnerable, Brightman said.
“These are people whose lives are not anything people would want to try,” Brightman said, calling them lives that do not “provide for margin of error.”
At a July 30 meeting, DSS told Legal Aid that staff shortages have slowed provision of hearing transcripts for appeals to circuit courts, Brightman said.
However, the agency didn’t offer an explanation of the new reluctance to reverse a decision to deny or re-evaluate benefits.
‘Misapplications of the law’
DSS directs indigent Missourians to Legal Aid if they choose to contest a benefits decision.
Three years ago, Legal Aid had an 85 percent win rate. Their clients fared better than the vast majority of those who go before a hearing officer without representation.
While losses began to mount in 2017, it was October of last year when the numbers “completely dropped off the planet,” Brightman said.
Answers as to why more people, including their clients, were losing disability cases were not immediately apparent.
“There’s been no systemic change in the law or anything to explain that kind of precipitous change,” Brightman said.
While the state has shifted from a Democratic administration to one with Republicans at the helm, Brightman said he didn’t think it had any impact.
“There have been some changes in personnel in the agency that may explain some of it,” Brightman said, saying DSS has experienced turnover in middle management.
“Misapplications of the law” is what Brightman believes is the leading cause.
DSS has an obligation to regularly re-investigate those who use the program and to make findings based on medical records, he said. They issue a notice of “adverse action” to those whose benefits are either denied or re-determined.
The beneficiary can request a DSS hearing officer revisit the case. Usually within 30 days of a hearing, the officer makes a recommendation to either affirm DSS’s initial decision or reverse it. The finding is then reviewed by the staff of the Family Support Division and signed off by its director.
In recent hearings, Brightman has seen DSS no longer consider medical evidence obtained by Legal Aid between the issuance of an adverse action notice and a client’s hearing. That evidence could be testimony from a physician or test results.
“What they are saying is they won’t consider evidence that wasn’t in existence at the time of their action, which is ludicrous,” Brightman said.
Brightman said that a new standard has emerged, as well.
Instead of looking at whether an applicant or beneficiary has been disabled for the last 12 months, hearing officers want proof that the person will be disabled for the prospective 12 months.
“Now they are requiring at this point in time, ‘Do you have a disability going forward that we can predict is going to last another 12 months?’ Brightman said.
Brightman said DSS has given the appearance of ignoring evidence that favors Legal Aid’s clients.
For example, DSS didn’t consider two MRIs provided by one of Brightman’s clients that shows the man has a degenerative disc disease. Managed care visits have documented that he can’t walk more than 50 feet.
“He’s languishing hoping he can be approved for Medicaid because he can’t afford his medications now,” Brightman said.
The man’s hearing was held in August of 2017. He submitted a notice to DSS the next month that he would appeal to the circuit court. More than a year later, in October of last year, he received a docket number.
The man’s case is still awaiting review in Jackson County Circuit Court.