Non-citizen claims pull Michigan Medicaid agency back to court

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A non-citizen resident and a refugee can continue with their lawsuit against the Michigan Medicaid agency that originally told them they were only eligible for emergency services, a court has ruled.

Aelen Unan and Patricia Quintino sued the state in 2014, saying that the Department of Health and Human Services failed in a variety of ways, including erroneously telling them they were not eligible for full coverage and by not providing information on how to seek comprehensive Medicaid.

After they filed their lawsuit, Unan and Quintino were given notice they were eligible for Medicaid coverage. DHHS began reprocessing and fixing claims through the year, and the state blamed technical problems for the errors. By the end of 2014, it had reprocessed more than 16,000 cases, according to court records.

The state said that by addressing its computer problems, the lawsuit became moot. A lower court agreed, but in a March 31 ruling from the U.S. Court of Appeals for the Sixth District, Judge Karen Nelson Moore said the plaintiff's claims “are not moot” and that they were “entitled to judgment as a matter of law on the remaining notice claims.” At issue is whether the state “picked off” the plaintiffs and gave them Medicaid coverage after they filed a lawsuit.

In a dissenting opinion, Judge Jeffrey S. Sutton said the state had solved its problems to the best of its ability. He noted that in three months in 2015, DHHS received Medicaid applications for more than 230,000 people, assigning Emergency Services Only for 4,378 individuals. There were 0.011% of people erroneously assigned ESO, he wrote.

“It is inevitable that errors will occur in implementing any complex benefits programs. Just look at the Social Security program,” he wrote. “The ‘systematic error' is the fact that no one person, and thus no one computer system, is beyond reproach. That's not enough to maintain a case or controversy in any setting.”