State Has Paid More Than $1 Million in Penalties for Late Hearings; Total Will Rise

by David Gorn

The Department of Health Care Services has sent more than $1 million in penalty checks to some beneficiaries in the Community Based Adult Services program due to long delays in appeal hearings over beneficiaries' eligibility status, according to DHCS officials.

About $1.2 million in penalties has been paid to 486 appellants and there are another 670 checks waiting in the queue.

DHCS officials did not have an estimate of how much money those additional 670 checks represent. They are "still being processed," according to Norman Williams, deputy director of communications at DHCS.

The average amount of the checks sent so far is $2,430 per person.

"That's a lot of money to be spending because you couldn't get your hearings out on time," said Elizabeth Zirker, staff attorney at Disability Rights California.

The state has 90 days to process fair hearings for CBAS eligibility appeals. If  the ruling finds the appellant eligible for the program, the state must pay $100 a day for each day past the 90-day limit.

Of the 2,370 CBAS hearings held last year, 1,235 of the appellants were found to be CBAS-eligible and 1,156 of the decisions went longer than 90 days, according to Williams.

Williams said the lawsuit settlement that created the new CBAS Medi-Cal benefit "resulted in a large volume of fair hearings requiring new processes that called for the State Hearings Division to gear up to handle the hearings in a short period of time," Williams said.

He added that a test period was established "to work all of the kinks out of the system and ensure that the fair hearings were able to proceed smoothly." That resulted in a delay for some of the CBAS fair hearings, Williams said.

"The end result was that the claimants had an opportunity to present their case to an impartial, informed tribunal," Williams said.

Zirker said appellants were happy to get their penalty checks, but they had no idea what the checks were for, since there was no letter or explanation sent with the checks.

"Normally, a notice is sent with the penalty checks," Williams said. "However, because the internal process was different for the CBAS penalty payments, staff processing the payments did not realize that an explanatory notice was needed. This has been remedied and all new penalty payments sent out have or will have an explanatory notice."

Williams said 131 penalty checks were sent without accompanying explanation.

A letter has been sent to CBAS providers about the payments, Williams said. This topic will be addressed this week at a meeting of the County Welfare Directors Association of California, Williams said.


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