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Medicare Beneficiaries Sue to End Delays in Funds to Pay Premiums

PHILADELPHIA – Claiming harmful and illegal delays in enrollments for benefits to pay Medicare premiums, low income Medicare beneficiaries and advocacy organizations have filed suit in the United States District Court for the Eastern District of Pennsylvania against the federal government and the Pennsylvania Department of Public Welfare.


"These delays are unconscionable in this era of instant data exchange," said Amy Hirsch, an attorney with Community Legal Services, Inc., in Philadelphia, who is representing the plaintiffs. "We see a steady stream of clients who are struggling to pay bills, or having to rely on others for help because of the high cost of their Medicare Part B premiums, which are supposed to be paid by the government."


Plaintiff Narcisa Garcia was just getting by on a monthly income of $695. Although she was found eligible last November for benefits to pay her $96 monthly Medicare Part B premium, she has yet to receive those benefits. Instead, her Part B premium is improperly deducted from her Social Security check each month, reducing her monthly income to $599. "I just want them to stop doing this to people like me. I barely have enough money to live on even before they took away the $96 each month," Ms. Garcia said.


Sau Lin Sum So, the other individual plaintiff, has been trying to get help with her Medicare premiums since last September, yet her Social Security benefits continue to be reduced by the $96 each month. Joining the individual plaintiffs are two organizations that assist Pennsylvanians who are eligible for Medicare and Medicaid assistance, The Center for Advocacy for the Rights and Interests of the Elderly, and The Arc of Pennsylvania.


The program at the heart of the suit, the Medicare Savings Program, requires the accurate matching of data by the state Medicaid agency, the federal Social Security Administration and the federal Department of Health and Human Services. The federal agencies' data sharing practices result in significant delays in getting benefits to elderly and disabled Pennsylvanians, causing them to forgo needed health care or cut back on other necessities.


The primary problem is that the federal agencies will only accept data from the state Medicaid agency once a month, and will only reply once a month to the state Medicaid agency. “The unnecessarily slow process creates a built-in delay of two to three months, even if everything goes perfectly. A minor glitch on the state or federal side can take months to work out, all while low income elderly or disabled individuals endure significant hardship” said Hirsch.


Plaintiffs are asking the court to recognize the case as a class action, to declare the government's practices illegal, to require that benefits are provided promptly, to require that beneficiaries be notified of delays in processing, and to require that beneficiaries be notified that they might be entitled to a refund of back benefits.


Plaintiffs in the case are represented by Hirsch and other attorneys from Community Legal Services, Inc., in Philadelphia, and by several attorneys from the Center for Medicare Advocacy, Inc. in Mansfield, Connecticut and Washington, DC.


A copy of the complaint is available at:


CLS attorneys are available for interviews:


Amy Hirsch at or 215-227-2400, ext. 2415.

Pamela Walz at or 215-227-2400, ext. 2431.

John Whitelaw at or 215-227-2400, ext. 2445.

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