State blames five-month bungling of Medicaid case on ‘computer glitch’

Last month, 82-year-old Viola Weir received a letter from the state that rejected her request for Medicaid benefits to pay for nursing home care. The letter from the New Mexico Human Services Department (HSD) said she had not provided the state agency with “the mandatory documents we need to decide if you can get benefits.” […]

State blames five-month bungling of Medicaid case on ‘computer glitch’

Last month, 82-year-old Viola Weir received a letter from the state that rejected her request for Medicaid benefits to pay for nursing home care.

The letter from the New Mexico Human Services Department (HSD) said she had not provided the state agency with “the mandatory documents we need to decide if you can get benefits.” As a result, the department denied Viola Weir her Medicaid benefits.

The very same letter also said her income levels and assets met the qualifications to receive such care.

That’s according to documentation that Tom Kovach, Weir’s son-in-law, sent to NM Political Report from HSD, the state department which processes federal benefits.

To Kovach, the letter didn’t make sense.

“In the same letter it says she’s qualified but it didn’t get [her] documents,” he said. “It just completely contradicts itself.”

A spokesman with HSD did not return emails or phone calls from NM Political Report seeking comment on this story.

By documents, Kovach is referring to Viola Weir’s financial statements that he and his husband, Will Weir, sent to the HSD as part of her Medicaid application on Dec. 5. Both Kovach and Will Weir, the son of Viola, say the case should have been a no-brainer. Viola had previously been on Medicaid for years while she worked at a restaurant.

Then, last November, her medical conditions made living in a nursing home a necessity. Kovach and Will Weir helped her apply for Institutional Long Term Care Medicaid, a type of federal benefit that pays for the elderly poor to receive care in nursing homes.

Will Weir said that on Dec. 15, an HSD caseworker told him his mother’s previous history with Medicaid would make processing her application “the easiest case ever.” One week later, HSD sent a letter acknowledging receipt of Viola Weir’s financial documentation—the same documentation that four months later it said it didn’t have and rejected her case.

Months went by with no update from the state on the status of the Medicaid application. Meanwhile, Viola Weir’s unpaid bills at the Raton Nursing and Rehabilitation Center continued to pile up. The costs added to more than $20,000, according to the Kovach and Will Weir. The Raton nursing home did not comment on the matter for this story.

Federal laws prevent nursing homes from kicking out residents who are unable to pay for their care after they’re admitted. That means nursing homes can go unpaid for months at a time.

Finally, on April 5, HSD delivered the contradictory letter rejecting Viola Weir’s Medicaid benefits.

The four-month waiting period was much longer than the 45-day federal requirement for states to process Medicaid applications.

In the end, it turned out that HSD was in error in rejecting Viola Weir’s Medicaid application. They later attributed the mistake to a computer glitch, according to Kovach and Will Weir, and last week finally accepted Viola Weir’s Medicaid application.

“What should have been an easy case took five months,” Kovach said.

Not an isolated case

This isn’t the only time HSD has botched a patient’s Institutional Medicaid application, according to health care advocates and long-term care organization officials interviewed for this story.

“It seems to be a very pervasive problem,” said Collin Baillio, a spokesman for Health Action New Mexico, a nonprofit healthcare advocacy group. “In some of these cases these are the folks that need care the most, and it puts them in tough spots.”

Linda Sechovec, executive director of the New Mexico Health Care Association, which represents long-term care providers, said the long processing times “got a lot more difficult over the last year or so.”

“The big issue, of course, is any business would struggle with delivering services and then waiting for payments,” she said.

But Sechovec emphasized that both her organization and the state have been “working together to speed up hold times.”

She called cases that take four to five months to process—cases like Viola Weir’s—”extraordinary.” Sechovec said HSD has been willing to review such cases.

“For a family member this has to be exasperating, when they’re caught between eligibility and the facility not being paid,” she said.

Reasons for the long application processing times can differ. Sometimes the applicant is at fault. Or the complexity of the process for getting Institutional Medicaid can be daunting.

“Sometimes getting bank statements and information on assets takes longer than, for example, a young person bringing in their pay stubs or notices of when they lost their job,” Sechovec said. “If the family [applying] has everything, it moves a lot more quickly than if the family has to go on a treasure hunt.”

Overloaded HSD caseworkers and high turnover at the agency are problems, too, she said. As of early April, there were 431 vacancies at the agency, which fully staffed, should employ 2,084 people.

Senior Citizens Law Office Executive Director Ellen Leitzer said that clients applying for Institutional Medicaid often have to submit their financial documents to the state multiple times.

“That’s something we see, is documents being lost that we submitted, as in a lot of bureaucracies,” Leitzer said.

In Viola Weir’s case, Kovach and Will Weir made calls to HSD and the governor’s office before her situation was resolved. Eventually, Will Weir said, an Income Support Division staff manager explained the “computer glitch.”

“The way they explained it to me is if [the case] comes to five or six months, the computer automatically denies it,” he said.

If that’s true, both he and Kovach said the state’s wrongful rejections of people’s applications to Institutional Medicaid may be a frequent occurrence.

“From what they told us on the phone, there’s a lot of these cases and they have a committee reviewing them,” Kovach said. “For us, here’s a case that should have never been denied and yet was automatically denied.”

We're ad free

That means that we rely on support from readers like you. Help us keep reporting on the most important New Mexico Stories by donating today.

Related

Emily’s List endorses seven candidates for Legislature

Emily’s List endorses seven candidates for Legislature

Emily’s List, a nonprofit that supports women candidates and reproductive rights, endorsed seven incumbents facing general election opponents in New Mexico legislative elections. All…
Equality New Mexico endorses 15 legislative candidates

Equality New Mexico endorses 15 legislative candidates

A New Mexico-based LGBTQ rights organization endorsed 15 candidates for state House and Senate seats for the 2024 elections.  Marshall Martinez, executive director of…
Lujan Grisham pocket vetoes two bills

Lujan Grisham pocket vetoes two bills

Gov. Michelle Lujan Grisham pocket vetoed two bills the legislature passed this legislative session: one changing the Cybersecurity Act and the other concerning law…
BLM announces final methane waste rule

BLM announces final methane waste rule

The federal Bureau of Land Management announced its final methane waste rule on Wednesday. These new regulations clamp down on the practice of venting…
What consumers, farmers should know about the flu impacting dairy cows

What consumers, farmers should know about the flu impacting dairy cows

Migrating birds appear to have caused a virus in dairy cattle that is causing reduced milk production. So far, the disease, which initially started…
Republicans seek to limit national monument designations

Republicans seek to limit national monument designations

Republican-backed legislation in the U.S. Congress would make it harder for the government to designate new national monuments. The proposed Congressional Oversight of the…
Amid new graduation requirements, what do high schoolers want to learn?

Amid new graduation requirements, what do high schoolers want to learn?

By Margaret O’Hara, The Santa Fe New Mexican The main things that bring Brayan Chavez to school every day: Seeing, talking to and engaging with…
Special ed teachers hope lawmakers OK pay raises, admin changes

Special ed teachers hope lawmakers OK pay raises, admin changes

By Margaret O’Hara, The Santa Fe New Mexican Brittany Behenna Griffith has a laundry list of adjectives to describe the ideal special education teacher:…
Lawmakers must find consensus on competing education spending plans

Lawmakers must find consensus on competing education spending plans

By Margaret O’Hara, The Santa Fe New Mexican A challenging task awaits New Mexico lawmakers in the next 30 days: Reconciling three very different…
Health workers fear it’s profits before protection as CDC revisits airborne transmission

Health workers fear it’s profits before protection as CDC revisits airborne transmission

Amy Maxmen, KFF Health News Four years after hospitals in New York City overflowed with covid-19 patients, emergency physician Sonya Stokes remains shaken by…
Lujan Grisham, Biden admin announce $10 million in federal funds for tribes, pueblos

Lujan Grisham, Biden admin announce $10 million in federal funds for tribes, pueblos

Gov. Michelle Lujan Grisham announced Friday $10 million in funding from the federal American Rescue Plan Act was awarded to six tribal nations and…
Proposal to curb executive powers moves to House Judiciary

Proposal to curb executive powers moves to House Judiciary

The House Government, Elections and Indian Affairs Committee discussed a potential constitutional amendment that seeks to limit the governor’s executive powers. The committee approved…
U.S. Supreme Court hears case to restrict access to medication abortion

U.S. Supreme Court hears case to restrict access to medication abortion

The U.S. Supreme Court heard the case about the regulations around mifepristone, one of a two-step regime for abortion medication, on Tuesday. FDA v.…
At stake in mifepristone case: Abortion, FDA’s authority, and return to 1873 obscenity law

At stake in mifepristone case: Abortion, FDA’s authority, and return to 1873 obscenity law

Lawyers from the conservative Christian group that won the case to overturn Roe v. Wade are returning to the U.S. Supreme Court on Tuesday in pursuit…
Supreme Court to hear two abortion cases this spring

Supreme Court to hear two abortion cases this spring

Later this month, the U.S. Supreme Court will hear oral arguments on the case against the abortion medication mifepristone. It will hear a second…
New Mexico Medicaid to cover cost of over-the-counter oral contraception

New Mexico Medicaid to cover cost of over-the-counter oral contraception

New Mexico Medicaid announced on Wednesday that it will cover the cost of Opill, the first oral contraception approved for over-the-counter use. It is…
U.S. Supreme Court hears case to restrict access to medication abortion

U.S. Supreme Court hears case to restrict access to medication abortion

The U.S. Supreme Court heard the case about the regulations around mifepristone, one of a two-step regime for abortion medication, on Tuesday. FDA v.…
At stake in mifepristone case: Abortion, FDA’s authority, and return to 1873 obscenity law

At stake in mifepristone case: Abortion, FDA’s authority, and return to 1873 obscenity law

Lawyers from the conservative Christian group that won the case to overturn Roe v. Wade are returning to the U.S. Supreme Court on Tuesday in pursuit…
San Juan County, Navajo Nation settle redistricting case

San Juan County, Navajo Nation settle redistricting case

The Navajo Nation and San Juan County reached an agreement Monday about commission districts after the tribe alleged that its members were not adequately…
MIT ranks NM elections most well-run in the U.S.

MIT ranks NM elections most well-run in the U.S.

New Mexico’s 2022 election was ranked most well-run in the country by Massachusetts Institute of Technology’s Election Data and Science Lab’s Elections Performance Index.…
Emily’s List endorses seven candidates for Legislature

Emily’s List endorses seven candidates for Legislature

Emily’s List, a nonprofit that supports women candidates and reproductive rights, endorsed seven incumbents facing general election opponents in New Mexico legislative elections. All…
BLM announces final methane waste rule

BLM announces final methane waste rule

The federal Bureau of Land Management announced its final methane waste rule on Wednesday. These new regulations clamp down on the practice of venting…
U.S. Supreme Court hears case to restrict access to medication abortion

U.S. Supreme Court hears case to restrict access to medication abortion

The U.S. Supreme Court heard the case about the regulations around mifepristone, one of a two-step regime for abortion medication, on Tuesday. FDA v.…
What consumers, farmers should know about the flu impacting dairy cows

What consumers, farmers should know about the flu impacting dairy cows

Migrating birds appear to have caused a virus in dairy cattle that is causing reduced milk production. So far, the disease, which initially started…

GET INVOLVED

© 2023 New Mexico Political Report