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Should I Contact an Attorney If I Was Kicked Out Of The Oregon Medicaid Program?

On behalf of The Johnston Law Firm, LLC posted in Insurance on July 28, 2017

Oregon has invested millions of dollars in establishing a new digital program for the state to qualify applicants and dispense Medicaid benefits. While glitches within the system were being worked out over spring 2017, significant numbers of people received waivers that allowed them to obtain benefits they were not otherwise entitled to. In the aftermath, many have now been kicked out of the program and have had previous claims denied. In you are one of those affected, your best option is to contact our experienced Portland trial and civil litigation attorneys, who can advise you on your rights to appeals.  

New System Creates Problems For People Receiving Medicaid Benefits In Portland

A June 2017 report by Oregon Live outlines some of the recent problems that have thwarted progress in updating the state’s Medicaid IT system. After spending more than four years and over $166 million to automate Medicaid enrollment, program glitches resulted in billions of dollars worth of payouts to recipients who were given waivers until their eligibility could be confirmed. Now that the system has resumed verifying their status, hundreds of thousands of people have had claims denied and have been kicked off of the program.

The new IT system, known by the acronym ONE, was designed to be a vast improvement over its predecessor, Cover Oregon, which served more than a million residents. It was also supposed to reduce staffing costs and make claims processing easier. Unfortunately, issues with the program resulted in the need to add roughly 600 full-time, temporary employees to answer the more than 120,000 calls the agency has received from clients waiting for information on their benefits and eligibility status. The program is now up and running, but there are still backlogs in people seeking additional information on their rights to benefits, as well as those appealing denied applications.

Your Rights In Appealing Medicaid Decisions

If you are one of the estimated 300,000 people who have been denied benefits or kicked out of the Medicaid program under the new IT system, it is important to be aware of your rights in appeals. Under Section 410-141-0000 of the Oregon Administrative Rules (OAR), you may be entitled to appeal an eligibility or benefit determination decision made by the Oregon Health Authority in the following types of cases:  

  • If you received a denial or limited authorization for services;
  • If benefits you were receiving were reduced, suspended, or terminated;
  • If a specific payment for services received was denied or only paid in part;
  • If services were not delivered in a timely manner.

Depending on your situation, your first step would be to either file a complaint with the Oregon Health Plan, or to request a hearing to appeal your determination. You have the right to be represented by an attorney in these matters, but you only have a limited amount of time to take action once you have received notice of a denial, reduction, or non-payment. Call or contact the Johnston Law Firm online right away to request a free consultation to discuss your situation. We can advise you on the best course of action so that you can get the benefits you are entitled to.  

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