Out of hundreds of thousands of South Carolina people who stand to lose some type of Medicaid coverage, 21 have used their option to appeal the decision.
Advocates and lawyers say that's because the extent of specific cuts is murky, the public notices hard to decode and Monday's mass appeal hearing in Columbia an unusual forum that makes it hard to travel and harder to mount an argument in a 15-minute time limit.
The services cut are optional under Medicaid, but the mentally disabled in particular could end up being forced into an institution - a violation of federal law - without some of the care that helps them adapt to the community, said Susan Lait, a former commissioner at the state Department of Disabilities and Special Needs whose child is losing some of that support.
Patricia Harrison, an attorney who has sued the state over separate service cuts, said the hearings are "for show," and that hearing officers are likely to affirm the reductions announced by the state Department of Health and Human Services.
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Jeff Stensland, a spokesman for the agency, said he can't say what hearing officers might do, and it's important for them to maintain independence. He said the public notices went out to more than 400,000 people who could be affected now or in the future, met federal regulations and gave people enough time to make arrangements for the trip to Columbia.
He said DHHS is still trying to close a $125 million deficit this year, though that's less than a previous gap, and that the agency decided to hold a group hearing because of multiple appeals on the same issue.
Medical privacy laws keep the hearing from being open to the public, Stensland said.
Sarah St. Onge, an attorney with Protection and Advocacy for People with Disabilities Inc., said she's never before seen a 15-minute time limit.
Meanwhile, St. Onge said it's hard to grasp exactly what people stand to lose.
"Sometimes it seems like policies and rules are written in a way to be confusing and to create barriers to accessing the process or services," Lait said.
As it stands, podiatry, vision, dental care, insulin pumps and wheelchair accessories are eliminated, while home health visits, child therapies and other care is reduced. Copays for many people on Medicaid are going up.
St. Onge and Harrison said people had 30 days to appeal, but the notice many received wasn't dated, wasn't marked as important and not clearly from DHHS.