State hearings officer rips agency for handling of Missoula family’s Medicaid case

2014-02-10T02:00:00Z 2014-05-29T16:01:17Z State hearings officer rips agency for handling of Missoula family’s Medicaid caseBy MIKE DENNISON Gazette State Bureau The Billings Gazette
February 10, 2014 2:00 am  • 

HELENA — For Missoula electrician Bill Fister and his family, trying to obtain and determine Medicaid benefits for his aging parents had become a “nightmare” they thought would never end.

“We as a family have done everything we could to pay for our parents, until we were hanging on for dear life to keep our company afloat,” Fister said.

But now, the nightmare may be over — thanks in part to a scathing opinion by a state hearings officer, who last month blasted the state agency handling Medicaid and called its actions in the Fister case “unconscionable,” a “deception” and “an incomprehensible mess.”

“The cruel irony is that people who cannot afford to pay for their own health care are often forced to pay lawyers instead,” wrote Bridgitt Erickson, chief of the Office of Fair Hearings in the Department of Public Health and Human Services. “Nobody should have to pay a lawyer simply to understand the department’s Medicaid process.”

Medicaid, the state-federal program that pays medical bills for the poor, covers about 7,000 elderly Montanans in nursing or assisted-living care.

Erickson, an attorney, ruled Jan. 21 that Medicaid owes the nursing homes caring for Fister’s parents as much as $8,600, to cover costs incorrectly denied as long as 18 months ago.

But Erickson didn’t stop there. She slammed her own agency for having a “frequently dysfunctional” computer system, for improperly using that system as excuse to miscalculate the Fisters’ benefits, for ignoring a state law that requires the agency to make Medicaid understandable to the average person, and for trying to deceive the Fisters into dropping their request for a hearing.

“It is wrong for anybody to engage in such manipulation, but for public employees who have the privilege of serving people who need help to obtain life’s basic necessities (food and health care), it is unconscionable,” Erickson wrote in her decision.

Richard Opper, director of the department, said late last week it will not appeal Erickson’s decision, and that he basically agrees with it.

“We didn’t handle this well,” he said. “We’re going to make it right for the family. … I wish I could say we disagreed with the findings here, I wish I could say we were blameless here. We need to improve.”

Opper said the agency will investigate some of the more serious findings in Erickson’s decision, as well as create new training for staff on how to handle such cases and make the Medicaid eligibility system more “user-friendly.”

Fister said last week he’s been told the past-due bills have been paid to the Missoula homes that separately house his parents, Elsie and Gale Fister, and that errors in the coverage amounts have been corrected. Elsie is 90 years old, and Gale is 83.

Fister said he felt compelled to speak out about his experience, because he suspects other Montanans have faced the same quagmire and been unable or unwilling to slog through it.

“What’s happening to the people who aren’t fighting it?” he said. “I know what’s happening — they’re screwing them over. … My story is a story of someone who’s done everything right and been dragged through the wringer on this thing.”

To qualify for Medicaid coverage of nursing home costs, an elderly Montanan cannot have assets of more than $2,000. Most of their income helps pay the cost of their care.

Fister’s mother has been in a nursing home since 2006 and his father has been in a home since 2008. Both have dementia or Alzheimer’s disease.

Fister says the family used his parents’ assets and income, their own money and a $100,000 loan to pay the costs until mid-2012, when the money was pretty much gone. Their business, Fister Electric, already hurting from the 2008-09 recession, also had lost two major clients when the Smurfit-Stone Mill and Stimson Lumber plants in Missoula shut down.

To qualify the parents for Medicaid, the family bought the parents’ homes in a complex real estate deal that was approved by Medicaid, allowing them to keep their business at its current location and creating rental income to help pay the nursing home costs.

The parents’ Social Security income also went to the homes, but Medicaid was to pay the rest — several thousand dollars a month for both of them, once they became eligible.

Fister says the family got a Medicaid card in July 2012, indicating his mother had been approved. They later began the process for his father, getting a notice that his father would be eligible starting February 2013.

But the state’s Medicaid system began sending a series of confusing notices with constantly changing amounts of money the Fisters owed for their mother — amounts Fister believed were inaccurately high.

The state also said the father, Gale Fister, hadn’t been eligible for Medicaid until April 2013, and that the Fisters owed an additional $3,800 to the home where he was staying.

As Fister tried to sort out the conflicts, state Medicaid staff frequently blamed problems on the state’s new, malfunctioning Medicaid computer system, he says.

Finally, last summer, after spending $10,000 to $15,000 on legal fees on the whole process and 200 to 300 hours of personal time as well, Fister says he decided to take the case to a hearing, to recover the unpaid money.

He represented himself at the Oct. 1 hearing in Missoula and had help from a paralegal, while the state had four staffers.

Not long before the hearing, Medicaid staffers offered to pay $4,600 to the father’s home if Fister would agree to cancel the hearing. Fister says he determined that the $4,600 was merely a transfer of money already paid by Medicaid, and refused the offer.

In her Jan. 21 decision, Erickson said the offer was tantamount to a “bribe,” to convince Fister to give up his right to a hearing, and was “deception.”

Erickson also ruled that the state had deliberately overcounted Elsie Fister’s income by $400 a month for a year, thus improperly increasing the amount she owed, and had never told the Fisters about the improper calculation.

Bill Fister says the family never wanted to rely on Medicaid to pay the bills for their parents, but when it became clear they couldn’t survive financially without it, it shouldn’t have been so difficult to sort out.

“The process shouldn’t be that horrific,” he says. “We’ve never tried to get away from paying anything. We’re just trying to save our business so we can feed our own families.”

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