Medicaid and Access to the Courts | Health Policy and Reform

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by Sara Rosenbaum, J.D. in New England Journal of Medicine

The Medicaid program is grounded in a statute that is one of the most complex of all federal laws. An insurer of more than 60 million people — and poised to begin serving 16 million more by 2019 — Medicaid will be reexamined this year, in all its legal complexities, by the U.S. Supreme Court, which has agreed to hear California’s appeal in the case Maxwell-Jolly v. Independent Living Center of Southern California. The Court’s ruling could fundamentally alter states’ accountability to beneficiaries and providers when their official conduct allegedly violates Medicaid’s essential federal requirements.

The Maxwell-Jolly case was precipitated by a series of deep cuts to provider payments that were enacted by the California legislature and aimed at services used predominantly by the state’s most severely disabled beneficiaries. The payment reductions were halted by the U.S. Court of Appeals for the Ninth Circuit, but this action by no means ended the dispute. Indeed, the question before the Supreme Court is of far greater consequence than that of specific provider payments: it is whether beneficiaries and providers have the right to seek judicial redress when they allege that state conduct abridges federal law and threatens health and safety.
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Henderson v. Shinseki, U.S. Supreme Court Permits Veterans' Delayed Challenges of Denial of Benefits

by Barbara Jones, Sr. Attorney | from: AARP Foundation Litigation

AARP had asked the U.S. Supreme Court to overturn a ruling that imposed rigid, inflexible rules that harm disabled veterans seeking to appeal the denial of their benefits.

Read AARP's Amicus Brief (PDF)

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Income Level for Individuals Eligible for Legal Services Corporation Assistance

The Legal Services Corporation (``Corporation'') is required by law to establish maximum income levels for individuals eligible for legal assistance. This document updates the specified income levels to reflect the annual amendments to the Federal Poverty Guidelines as issued by the Department of Health and Human Services.

Effective Date: This rule is effective as of August 6, 2010.

Final Rule

Legal Service Corporation Improvements Needed

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The Legal Services Corporation (LSC) was created as a private, nonprofit corporation to support legal assistance for low-income individuals on civil legal matters, primarily through federal grants and is primarily funded through federal appropriations. Effective internal controls over grant awards and oversight of grantees’ performance are critical to LSC’s mission. GAO and the LSC Inspector General have previously reported weaknesses and made recommendations. GAO’s objectives for this report were to determine the extent to which LSC (1) implemented key internal controls in awarding and overseeing grantees, (2) measured its performance, (3) evaluated staffing needs, and (4) adhered to its budget execution processes.

GAO analyzed key records and prior recommendations as well as interviewed LSC officials regarding LSC’s internal control and performance frameworks, staffing, and contract processes.

What GAO Recommends

GAO makes recommendations to LSC management to improve internal controls over grant awards and oversight including such key areas as
(1) documenting specific controls over the grant application review, evaluation, and approval processes,
(2) implementing a tracking system for LSC’s recommendations, and
(3) establishing comprehensive performance measures linked to responsible offices. LSC agreed with GAO’s recommendations.
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States Awarded $700,000 for Enhanced Access to Legal Services for Older Americans

HHS Assistant Secretary for Aging Kathy Greenlee has announced the award of $700,000 to seven states to help at-risk older Americans have better access legal services.

Awards of $100,000 each were made to legal service provider organizations in Alaska, Delaware, Georgia, Massachusetts, Texas, West Virginia, and the District of Columbia. These grants will bring aging and legal service delivery systems together to improve efforts to protect the independence, health, and financial security of older adults. Many older individuals are facing critical threats to their independence, including the loss of their homes through foreclosure, the destruction of nest eggs through consumer scams, the risk of elder abuse, the challenges in accessing important public benefits, as well as the prevalence of health care fraud and financial exploitation.

“We know there are older adults who need legal assistance from time to time. This can be overwhelming as well as costly especially on a fixed income,” said Assistant Secretary Greenlee. “As a former elder law attorney, I know first hand that these programs help at-risk older adults and their caregivers avoid and address legal situations that may threaten their independence and quality of life.”

The grantees will work to develop statewide legal service delivery systems that coordinate efforts of senior legal help-lines, pro-bono attorneys, law school clinics, self-help sites, and Older Americans Act-funded legal services providers to ensure maximum impact from limited resources. The target populations are underserved seniors, with particular emphasis upon low-income, minority, rural, homebound, Native American, and limited-English speaking older individuals.

Through the “Model Approaches to Statewide Legal Assistance Systems” (Model Approaches) demonstration grants, the Administration on Aging (AoA) assists states in integrating help-lines and other low-cost legal assistance mechanisms as critical, permanent, and sustained components of comprehensive legal services delivery programs across the country. Upon completion of the three-year grant period, the Model Approaches projects will present cost-effective examples of well-integrated legal services delivery systems and strategies that increase overall service access for elders. It is anticipated that innovative service delivery models will emerge from these collaborative projects that can be replicated in other states that wish to target scarce resources and increase legal services to seniors in greatest social or economic need.

The Administration on Aging has now funded 31 Model Approaches projects to date. More information about AoA services and programs may be found at www.aoa.gov. For more information on AoA’s Legal Services programs, please visit:
http://www.aoa.gov/AoARoot/AoA_Programs/Elder_Rights/Legal/index.aspx