Three years ago, and after 9 months of battling my local Hospital District, I won health care for myself and others in my county. I knew the war wasn't won but that was as far as I could go under the rules. I have the opportunity to battle them again and I hope some of my 320,000 friends here will give me some advise while I prepare for battle.
Three years ago, my county's hospital district had rules in place requiring applicants for their program to live in the county for 30 days and that any applicants had to list the income and assets of all persons within the home they resided in when determining income and asset levels of applicants. The law was, and still is very clear that those requirements weren't supported by the law.
I will recount those battles as background here. It is the subject of a previous diary of mine: Victory! Tomtech wins Healthcare for the poor. You can skip down a bit for info on my new battle if you wish.
Relevant Health and Safety Code section:
Sec. 61.003 establishes the general residence requirements and includes the phrase "intends to reside" which is very broad since a person can change their intent at any time. That is what happened to me. I moved to my aunt's home and was looking for work there with the intent of staying there but after three months no jobs came up. During that time, I went on the program that county provided. I decided to stay at my parent's home and went to get coverage in the local county but I wasn't even given an application since I hadn't resided in the county for a full month. I blew off that and returned thirty days later.
As an aside: I have a cousin with severe cerebral palsy, whom I regularly live with at the same aunt's (his grandmother's) home and help when he has special needs which require someone in addition to his mother and grandmother to care for him. He is on 100% disability and I have had discussions with his mother about his eligibility for those programs. I knew that once he turned 18 his mother's income and assets were no longer relevant to his coverage for medical assistance and other programs.
An additional aside: When my grandmother was looking at her last days, due to smoking Camel Non-filters for over 40 years, my parents had hoped to allow her to live with them for as long as possible, but the rules providing her minimum medical coverage would have cut her off due to my parent's income and would have put my family's assets at risk. She was put in a nursing home for her final months and that ended up costing the State much more than it would have cost them if she had stayed with my parents for as long as possible.
Back to my tale: After 30 days I returned to get minimal heath care coverage ($5000/yr limit with no more than three prescriptions during each year). I was told that I would have to provide data on my parent's income, assets, and expenses in order to get coverage. I knew they had no right to do that because of my experience in another county with a similar program and my experience with my cousin. I was motivated because of what happened with my grandmother, a desire to ensure others can get the care the law allows, as well as a general motivation to stop a government entity from ignoring the law.
At that time, I knew I was in the right and figured that all I had to do was present my case and the Board members would realize the error of their ways and comply with my wishes. Yes, I was that naive.
I only had one opportunity each month to present my case and I was totally unprepared in September, but the clerk "failed" to place my presentation on the agenda so I wasn't allowed to discuss my issue.
I went to the magical information machine (my internet connected computer) and made a major discovery. The law wasn't as clear as I had hoped and nothing in the base law would help me in my plight. But then I discovered The Texas Administrative Code and it was clear that I was right on the two points I needed.
Rule §14.102(c) in Subchapter B of Chapter 14 within Part 1 of TITLE 25 there was very specific language that (t)here are no durational requirements for residency and Rule §14.102 had multiple sections which made it clear that I was a household of one even though I lived with others. And that the finances of the others had no bearing on the situation.
I had a few notes and thought I was prepared for the October meeting and I was allowed to start my presentation, but as soon as I mentioned the law, I was stopped cold because the District's Lawyer was unavailable since he was on "vacation".
I knew I needed more than I had and with another month to prepare, I was ready when November came around. I had a lengthy written presentation and a shorter written oral one. I had the law on my side. I had connected all the dots and was given the opportunity to present my case. The Board's Chairman had a well thought out reply. He didn't care what the law said, they wouldn't change their rules without a final court order which would take me years to get.
I was stunned. I truly thought elected officials tried to ensure their departments followed the law. That was a revelation in that these people didn't care what the law said and when faced with clear laws which conflicted with what they were doing they would force the people who cared enough to challenge them to go to court and persuade the court to force them to comply with the law.
I later learned that the last thing they wanted was a court order forcing them to comply and getting one is almost impossible.
I went to the nearest Legal Aid office and had an appointment to present my case on the day before Thanksgiving. I was approved and an expert on Health Care Law was assigned to my case. It took, what seemed like, forever for them to prepare the case but in early May they were ready and sent the draft legal filing to the Hospital District's Lawyer and a few day's later I was informed that they had caved on the time of residence and definition of Household for financial responsibility issues.
This is where I return to discussing my next battle.
I had won that round, but I knew there were other issues in which the district was failing to follow the law but, since I couldn't claim personal damages, I couldn't get them to change their policies. (I tried but going pro se isn't)
The district has a rule which stated that they won't even give out an application unless the applicant provides them with, and allows them to copy, their ID. I didn't object to that rule the first time I went there and they used the information from my ID to violate my 5th Amendment rights by performing an investigation on me without my consent. Since the application has a standard 5th Amendment waiver incorporated in it, they operate as if everyone waives their 5th Amendment Rights when they walk through the door.
For the last two years, I failed to have my ID with me when I went to renew my coverage and was given an application anyway since my ID was on file and the lady knew me. Since I wasn't refused, I had no standing to challenge the policy.
But this year they added a new requirement to get an application and I was refused the application. Hopefully, I can use that refusal to gain standing and force them to rescind the new policy and the ID requirement since my legal argument will cover both situations.
The law is clear this time and simply states Sec. 61.053.(c) The public hospital or hospital district shall furnish an applicant with written application forms. There are no ifs ands or butts applicable to that statement although the district's personnel have tried to apply the "but we don't have the money" provision (Sec. 61.054.(c)) but that provision is only applicable to their ability to limit services (I wish I could get a decision or law change which states that the "but we don't have the money" provision can only be used after the district maximizes their taxing authority and uses up any State funds available to them).
Their personnel have also tried to apply the "minimizing the opportunity for fraud" (Sec. 61.066) provision to cover the ID requirement, but there is no opportunity for fraud created by a person obtaining a stack of papers.
I am still stuck on the ID requirement which continually pisses me off and I hope to eliminate even though it isn't the reason I was denied an application.
I was denied an application because I didn't have a letter of denial for Medicaid from the Department of State Heath Services even though I know I am not eligible. Medicaid in Texas is only available under three programs. One covers pregnant women (I'm a man, baby). The second covers parents with under age children in their home. And the third covers grandparents with under age children in their home.
Since I needed to go to the Department of State Heath Services earlier this month for other reasons (a program I knew I qualified for and received) I actually asked for a Letter of Deniability for Medicaid. I haven't received such a letter but my ass is covered in that I actually attempted to get the document they required.
Today, when I tried to get an application for health care coverage and was denied, I tried to show them their hypocrisy by requesting a letter of denial from them but since I didn't have a letter of denial for a program in which I was ineligible to apply for I couldn't get a letter of denial from them because I was ineligible to apply for their program. I hope you caught that, and I wrote it correctly.
I also plan to go after them on the letter of denial issue since the law is clear that they must provide me a letter of denial (Sec. 61.053.(j)).
I asked to present a case to the Board concerning their requirement that people who are categorically ineligible for Medicaid prove that they wasted their time and the resources of The Department of State Heath Services just to delay or forego their application for coverage. I will discuss the ID issue also since they are both illegal requirements to get an application but my suggested remedy will be for them to assist persons who are pregnant or have children or grandchildren in their home in applying for Medicaid under the condition that they will be removed from the hospital district's program if they are approved for Medicaid.
This probably won't be my last fight in my war with the hospital district since they fail to meet the requirements of allowing three prescriptions per month. They only allow three prescriptions per year and hide behind the "we can't afford it clause" even though they could increase the tax rate and ask for additional funds from both the State and Federal Governments. I know from previous endeavors that they are afraid to allow the State and Federal Governments to get the opportunity to oversee or audit their program.
It is my belief that their failure to try and get more funds causes them to fail the legal requirement of Sec. 61.055.(b) to "endeavor to provide the basic health care services a county is required to provide" but until I am denied those services, I don't have standing to challenge them. In the last two years they waived their three prescriptions per year rule for me. Are they afraid of me, or is the rule just B.S. to keep people from asking for what they deserve?
Their personnel also keep using the "we will go broke, and have to disband" line on me regularly but it is my belief that, since we haven't had a hospital for twenty years, the needy in my county would be better served if the district disbanded and the, four to one Democratic, County Commissioners Court would make more of an attempt to follow the law and provide the coverage the poorest in my community deserve.
I hope some of the great lawyers in the community read this and give me any advice they feel is appropriate. I contacted Legal Aid, but I have to wait until tomorrow to apply for their assistance.
If you know of any rulings or general provisions of law which states that an entity cannot require an applicant to get a ruling from a third agency when the applicant is categorically ineligible for the programs the third agency administers let me know in the comments or via Kosmail.