State Agency's Penalty Check Payout for Late Hearings Climbs Above $2.7 Million

by David Gorn

The Department of Social Services has issued more than $2.7 million in penalty checks to Californians who successfully appealed their eligibility status for the Community Based Adult Services program, which was created and is overseen by the Department of Health Care Services.

In July, Capitol Desk reported the state had paid more than $1.1 million in penalties to 670 CBAS recipients.

DHCS officials yesterday said another $1.6 million in penalties will be paid to 145 successful eligibility appellants. For those new recipients, that's an average of more than $11,000 per penalty check.

In total, the state will pay almost $2.8 million to 815 recipients for an overall average of $3,400 per penalty check.

 "The state generally manages to provide claimants in fair hearings an expedient and fair process to address their issues," said Norman Williams, deputy director of public affairs for DHCS.

When Adult Day Health Care, a state-run program for Medi-Cal beneficiaries, was discontinued and replaced by the CBAS program in 2012, many people were denied eligibility and appealed those denials. The large volume of hearing requests required a new process to handle the hearings, Williams said.

Williams said the state needed extra time to set up test-case hearings first, which he said expedited later hearings, known as "fair hearings."

"Although this ultimately resulted in a delay for some of the CBAS fair hearings, and the imposition of some penalties, the end result was that the claimants had an opportunity to present their case to an impartial, informed tribunal," Williams said.

There is a 90-day deadline to follow through on fair hearings, and the state in some cases far exceeded that deadline. According to DHCS officials, the penalty payments ranged from as little as $100 to as much as almost $15,000.

From a total of 2,370 fair hearings, a little more than half -- 1,235 of them -- were decided in favor of the appellant who was granted eligibility. More than half of the successful appeals -- 815 -- were delayed and were awarded penalty payments.


to share your thoughts on this article.