Colorado Medicaid is discriminating against people with disabilities, federal complaint claims

Delays and convoluted policies that have plagued Colorado Medicaid for years are violating the rights of people with disabilities, according to a federal complaint against the program.

Colorado Medicaid, a government-funded insurance program for people with low incomes or severe disabilities, is failing to comply with the federal Americans with Disabilities Act, according to the civil rights complaint from the Colorado Center on Law and Policy and the National Health Law Program.

The state program, within the Colorado Department of Health Care Policy and Financing, is letting people slip through the cracks as it revamps its case management policies and its computer system, the complaint alleges. The changes are coming at a time when the Medicaid division has been overwhelmed with redetermining people’s eligibility, which was not required during a three-year pause during the coronavirus pandemic.

The complaint filed last week asks two federal agencies — the U.S. Department of Health and Human Services Office for Civil Rights and the U.S. Department of Justice — to take immediate action to help Coloradans. And they want the state Medicaid division to stop terminating services for people with disabilities until case management issues and computer system problems have been resolved.

These are people who are vulnerable.

— Bethany Pray, Colorado Center on Law and Policy

“These are people who are vulnerable,” said Bethany Pray, deputy director at the Colorado Center on Law and Policy. “They really need to have a case manager who knows what’s happening with them and is making sure they’re getting the services they need to stay healthy.”

Lene Jaqua is among the parents whose children have received letters in recent weeks notifying them they were no longer eligible for Medicaid. 

Jaqua’s son, 27, has been on a Medicaid program called a “supported living services waiver” since he became an adult. He lives with Jaqua, 62, and the waiver pays for the day program where he spends weekdays while she is working. 

At this point, Jaqua and her mom friends have had enough letters with bad news from Colorado Medicaid that her stomach sinks when she sees one in the mailbox. It’s almost always a documentation issue, one that takes her days to sort out so that her son, who has Down syndrome, was born with a heart defect, a cleft lip and palate, and uses an assisted technology device to communicate, can continue receiving services. Sometimes, she doesn’t open it until the next morning, in order to gather the fortitude to deal with it. 

The latest letter was in her mailbox Feb. 19. Her son was being kicked off Medicaid, it said, though there was no explanation about what paperwork she was missing. 

“The letter is six or seven pages and full of gobbledygook,” she said. “I have a Ph.D. in nuclear physics and I don’t understand this letter.” 

This time, it turned out that her son’s file was missing a document called a “level of care determination,” even though his case manager had sent it every year. Jaqua believes that the state’s computer program, not a live person, sorted through her son’s file, did not connect all the required documents, entered incorrect information about his income, and generated the letter notifying him he was no longer eligible. She was able to solve the issue by taking two days off work and having multiple conversations with her son’s case manager and Jefferson County Human Services. 

In the process, Jaqua realized the problems were widespread. Six other families at her son’s day program were going through the same thing, as were two out of 12 moms in a chat group who have been supporting each other through for years. 

Jaqua doesn’t blame anyone in particular, just the underfunded system that has case managers overwhelmed. 

State Medicaid officials at the Colorado Department of Health Care Policy and Financing said the department “takes seriously the concerns and is committed to ensuring members receive the services for which they qualify.” Department officials, in an email to The Sun, also acknowledged that those receiving long-term services are “experiencing compounding issues” because of the ongoing policy changes and the Medicaid redeterminations. 

“We are working closely with the advocacy community, members and families, Case Management Agencies, and providers to fully understand the issues that they are experiencing and to align our strategies to meet those needs,” they said. 

Service delays, confusing letters come as Medicaid overhauls policies

The state last year began overhauling its case management services, a monumental undertaking to solve a longtime concern.

In the past, the same agencies that determined who was eligible for services also provided those services. For years, advocates have complained the setup was a conflict of interest and gave the agencies too much power to spend the state and federal dollars. 

Under the new structure, the state is divided into 20 geographic areas and has contracts with agencies that will provide case managers to Coloradans with intellectual or developmental disabilities, brain injuries or severe mental health issues. Separate agencies will provide services. 

Once the transition is complete, Coloradans will receive case management services from the agency that holds the contract in their defined service area.