Bill would alter appeals process on kids’ care

Print Friendly and PDF By: Andy Miller Published: Feb 28, 2011

A House bill would help Georgia families who appeal the state’s denials of Medicaid services for medically fragile or disabled children, proponents say.

Currently, when Medicaid denies a treatment for a child, a family can appeal to the Office of State Administrative Hearings. If the administrative law judge rules in the family’s favor, the state’s Medicaid agency can reverse the judge’s decision.

House Bill 229 would make the judge’s ruling final — taking away the Department of Community Health’s power to overturn the decision. The legislation would also require Community Health to rule on a request for a medical treatment within 90 days, and then send a family’s appeal of a denial to the Administrative Hearings Office within 10 business days of receiving it.

A subcommittee of the House Judiciary Committee heard testimony Monday from the bill’s lead sponsor, Rep. Sharon Cooper (R-Marietta). Cooper told the panel that the decisions on care often involve treatments for medically fragile children, and those on the ‘’Katie Beckett” waiver program for children with disabilities.

Parents feel frustrated by the delays in Medicaid decisions, which can take eight to nine months, Cooper said.

The Department of Community Health opposes the legislation, seeking to retain the right to review a judge’s ruling. Medicaid, the health program jointly financed by the state and federal governments, covers about 1.4 million poor and disabled Georgians, most of them children. Proposed spending cuts have squeezed the Medicaid and Community Health budgets.

The children involved in these treatment decisions may need speech or occupational therapy, durable medical equipment, or a certain level of nursing care, said Pat Nobbie, deputy director of the Georgia Council on Developmental Disabilities, in an interview.

“Too many families get stuck in limbo during the Medicaid appeals process,’’ Nobbie said. The bill would make the procedure more efficient, she added.

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