✶ Victory for Medicaid Recipients in Wisconsin
"Hannah Balder and Disability Rights Wisconsin worked hard to ensure that I and all Medicaid recipients have a voice and the legal right to a state fair hearing. Thank you, Hannah, for getting us justice."
- Tamra Schott
Case Update The Wisconsin District III Court of Appeals reaffirmed a core right for Medicaid recipients: the right to a fair hearing to ensure services are not denied inappropriately. The decision upheld a prior order from court in Lincoln County in Schott v. Wisconsin Department of Health Services, which held Plaintiff Tamra Schott's rights were violated when her Medicaid-funded services through Wisconsin's Comprehensive Community Services (CCS) program were terminated without notice of the right to a fair hearing. What does this mean for Wisconsinites? This ruling highlights the right of individuals under the Due Process Clause of the 14th Amendment, and reiterates protections in federal and state Medicaid laws which protect Medicaid recipients as well as the role and responsibilities of the Department of Health Services (DHS) as the adminstering agency of Medicaid services in Wisconsin. DHS is responsible for the Medicaid services it funds in Wisconsin regardless of who it delegates to adminster the programs by county. Tamra's Story Tamra Schott is a Medicaid recipient who relies on community-based mental health treatment provided through Wisconsin's Comprehensive Community Services (CCS) program. DHS delegates implentation of Medicaid programs and services like CCS to Wisconsin counties, who then contract providers to adminster the programs. In 2023, North Central Health Care (NCHC), who administers the CCS program in Ms. Schott's county, chose to dismiss her from the CCS program. Under state and federal law, a Medicaid recipient has the right to a fair hearing to challenge the Department's decision when their Medicaid services are terminated, reduced, denied, or suspended. In the dismissal notice, Ms. Schott was not informed of that right. When challenged, DHS argued that the plaintiff did not have the right to a fair hearing because DHS did not terminate her from CCS, North Central Health Care did. On behalf of the plaintiff, DRW argued that Medicaid service participants have the right to a fair hearing when their Medicaid-funded CCS services are terminated, regardless of who adminsters the program at the county level. In its ruling last week, the Court of Appeals agreed with DRW.
"We are thrilled to see the Court of Appeals state firmly and clearly: the Wisconsin Department of Health Services must be held accountable for the Medicaid services and programs it provides for our state's most vulnerable citizens. This decision is a powerful and timely affirmation that Medicaid recipients have the right to be heard."
- Staff Attorney, Hannah Balder
What to dive deeper? View the ruling on our website here.
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