Posted on: Saturday, May 12, 2001
QUEST plaintiffs await ruling on appeal
By Ronna Bolante
Advertiser Capitol Bureau
When osteoarthritis, depression and severe hives forced Big Island resident Theodora Bell to leave her job in social services, she hoped some kind of "safety net" would help cover her medical bills.
At age 60 in 1993, Bell was still too young to qualify for Medicare, and the money she had saved for retirement also made her ineligible for coverage under Medicaid. Hawai'i established the managed-care QUEST program in 1994, and Bell wasn't sure she would qualify for that either.
But she had no idea she would be turned down on the basis of her disability.
"I was stressed that I didn't have medical insurance," said Bell, who also relied on a cane to walk at the time because of a deteriorating hip. "I had some resources. But as I paid them out, they depleted, which meant whatever I expected to live on in my retirement years was going down the drain."
Bell is one of more than 350 claimants in a 1997 federal lawsuit that alleged the original QUEST eligibility requirements violated anti-discrimination laws. About 20 cases were tried in U.S. District Court, where the state was ordered to pay about $764,000 to plaintiffs, Senior Deputy Attorney General Charles Fell said. The state has appealed those judgments and expects the 9th U.S. Circuit Court of Appeals to hand down a decision any day now, he said.
The state has already agreed to pay $304,000 to settle about 75 other cases where claims did not exceed $10,000, Fell said.
At this point, the state also faces about $1 million in outstanding attorney's fees, but "we risk paying out a lot more from state coffers if we lose the 9th Circuit cases," Fell said.
The state intended the QUEST program to provide universal health care. But the suit may end up costing millions over the claim that the state was discriminatory in excluding the disabled.
"If you were disabled and had the same economic status as a non-disabled person, you were not able to get medical benefits under the QUEST program," said Shelby Anne Floyd, an attorney for the plaintiffs.
Floyd said it is unlikely the Court of Appeals will reverse all of the judgments. If the court affirms those decisions, it could "open the flood gates" for the dozens of unresolved claims in the suit, she said.
The lawsuit alleged that QUEST — which then had more liberal financial criteria than the traditional Medicaid program — violated the federal Americans with Disabilities Act and the Rehabilitation Act by excluding the aged, blind and disabled from the program.
When the managed-care QUEST program was launched in 1994, it left about 32,000 aged, blind and disabled clients in the fee-for-service Medicaid program.
QUEST excluded residents from that population because of the anticipated high costs to the "experimental" program for providing care to that group, Fell said.
As a result, many of Hawai'i's aged, blind and disabled who did not meet Medicaid's financial criteria but qualified under QUEST requirements were denied insurance based on their disability.
The 1997 lawsuit was sparked by a 1995 case filed by a disabled minor on the Big Island who did not qualify for Medicaid but would have met QUEST's financial requirements. Shea Burns-Vidlak was awarded $20,704 in U.S. District Court, allowing disabled residents in similar situations to also sue the state.
In response to the 1995 lawsuit, the state has since overhauled QUEST financial criteria to match the more stringent income and assets requirements of Medicaid. The changes have cut more than 30,000 clients from the program.
"In a sense, the lawsuit was a very expensive one to those members of the public that lost their insurance because of the change apparently required by federal law, insofar as the federal district court has ruled," Fell said.
Director Susan Chandler said the Department of Human Services "always anticipated moving the aged, blind and disabled" into QUEST. The department plans to do so next year, she said.
"I think we were trying to expand health care as best we could to needy people in Hawai'i," Chandler said. "It was not the intention of the program to discriminate against anyone."
Both Fell and Floyd agree that the changes in QUEST requirements will preclude similar discrimination lawsuits in the future.
Bell said the state has appealed her settlement, which exceeds $10,000. That amount would cover attorney's fees and medical expenses she paid out of pocket between 1994 and 1996, when the state tightened QUEST's financial requirements, she said.
Now part of the state's Medicare program, Bell said, "If I were to get that amount I settled for, I would be grateful because it would help me pay for some of the other bills."
But she won't be sitting around waiting for it, she said.
Under Medicare, Bell has since had a hip transplant and now attends water aerobics classes. She will also be in Minnesota tomorrow for her 50th class reunion.
"I'm glad to be moving up and around and moving better," she said. "Plus my mental health is in great shape. There are a lot of projects I'd like to do."
