Advocates: Some Brain-Injured Patients Being Denied Help As State Keeps Treatment Slots Vacant

HARTFORD — The Department of Social Services is refusing to fill 19 treatment slots for people with acquired brain injuries, citing funding and staffing issues, while at least 22 families on a waiting list for these services are struggling to care for their loved ones at home.

Friday, more than 500 advocates and family members joined to send their second complaint in two months to federal Medicaid officials, asking that DSS be compelled to open the slots and provide the treatment services. The state receives a 50 percent reimbursement through Medicaid.

Federal authorities had approved Connecticut for 75 slots in one program but DSS is filling 64, state officials said Friday. In another program, for clients of the Department of Mental Health and Addiction Services, all eight slots are being kept empty.

DSS officials have asked the legislature for permission to hire a private vendor to manage the treatment, but lawmakers on the human services and appropriations committees, citing concerns over continuity of care and questions about DSS oversight, have blocked the privatization effort.

Currently, DSS social workers manage the care in the 64 treatment slots that are filled. DSS officials say the department doesn’t have the money to pay case workers to cover all of the slots.

“Could it be that brain injury survivors are being held hostage in order to force the citizens of Connecticut and legislators to comply with DSS’s unrelated demands?” the advocates’ complaint states.

DSS official Kathy Bruni has said her agency “lacks the staff to add any new clients to the [brain-injury treatment program]. Our solution to this problem is to seek a contractor to assume responsibility for the case management functions … Once that change is approved by the legislative committees … and the Centers for Medicare and Medicaid Services, we can begin” to accept new patients.

Meanwhile, people with traumatic brain injuries, and their families, are suffering the consequences, advocates say. The treatment slots offer a far wider array of services than patients can receive under traditional Medicaid coverage, said Wendy Wanchak, a lawyer in Connecticut Legal Services’ Willimantic office. She is representing one of the families on the waiting list.

Wanchak’s client was approved for one of the treatment slots, and given a date that the services were to start. The date came and went, with no services ever offered.

The family asked for a hearing with DSS and was denied.

“It’s sad that we’ve gotten to the point that people are being denied their most basic rights — a fair hearing is one of those rights,” said Wanchak.

DSS spokesman David Dearborn said people who are on a waiting list for treatment do not have a right to a hearing, but Wanchak and other lawyers for Medicaid clients strongly disagree with that contention.

Part of the DSS regulations say a person “has the right to a fair hearing if …the requester feels that the department has either failed to take a required action or has taken an erroneous action.”

Wanchak said that many patients with acquired brain injuries “begin to deteriorate without these services, and that is detrimental to the person, and everyone around them.”

Dearborn said the agency is unhappy about the the waiting list. He added that the treatment slots could be gradually filled if a private vendor was hired.

“Currently, we do not have enough social work staff to give the protection and oversight our clients need and deserve,” Dearborn said. “This is not something we can simply ignore.”

The latest complaint was sent Friday to the Boston regional office of the U.S. Centers for Medicare and Medicaid Services, or CMS.

“Your agency reimburses Connecticut about $3.5 billion per year for its Medicaid expenditures. Given this massive outlay, it is reasonable for your agency to ask, at a minimum, that the state comply with all the terms of its Medicaid State Plan,” the letter states. “We urge you to instruct DSS to do so, without any further delay.”

CMS had no immediate response to the complaint, but a federal official speaking on background said, “CMS assumes that Connecticut will fill the available slots; however, CMS does not have the authority to mandate that the state fill to the cap.”

Advocates, however, point out that when the state applied for the treatment slots, DSS said it would fill the entire treatment program.

There are two brain-injury treatment programs, and DSS officials said they had anticipated that some patients would leave the first program, thereby freeing up some state funding to cover the second. But when that happened, DSS said it was caught short.