CHARLESTON – A man is suing the West Virginia Department of Health and Human Resources for allegedly failing to administer the state’s Medicaid program in conformity with the federally approved West Virginia State Medicaid Plan.

Rocco S. Fucillo is the cabinet secretary of the West Virginia Department of Health and Human Resources.

Dwight Canfield is unable to engage in substantial gainful work activity due to multiple medical conditions, including rheumatoid arthritis, fibromyalgia, systemic lupus, depression, bilateral carpal tunnel syndrome, diabetes, high blood pressure and a seizure disorder, according to a complaint filed Dec. 17 in United States District Court for the Southern District of West Virginia.

Canfield claims the West Virginia Department of Health and Human Resources determined he was disabled, according to Supplemental Security Income standards and also meets other eligibility criteria for the SSI program, but does not receive cash assistance.

Because of this eligibility, Canfield is entitled to Medicaid without a spenddown, according to the West Virginia State Medicaid Plan, the complaint states.

Canfield claims due to the WVDHHR’s failure to implement and administer West Virginia Medicaid in conformity with the West Virginia State Medicaid Plan, he was only offered Medicaid in the Medically Needy Coverage Group.

As a condition of his inclusion in the Medically Needy Coverage Group, Canfield was required to spenddown $1,982.40 in medical expenses before receiving benefits, according to the suit, however, Canfield was unable to afford the nearly $2,000 in medical expenses and, as a result, was forced to cut many of his medications in half and go without necessary medical treatment.

Canfield claims due to the lack of proper medical treatment, he was admitted to the emergency room, causing him to incur significant medical expense that would otherwise be covered, had he been enrolled in the Optional Categorically Needy Disabled Group.

Fucillo has a clear legal duty to administer the West Virginia Medicaid program in conformity with the federally approved West Virginia State Medicaid Plan, but failed to fulfill his clear legal duty, according to the suit.

Canfield claims the defendant’s failure caused him damages.

Canfield is seeking a writ of mandamus ordering Fucillo to administer the West Virginia Medicaid program in conformity with the approved West Virginia Medicaid Plan and an order for Fucillo to appear before the Court on a designated day and show cause why he should not be ordered to provide such Medicaid coverage. He is being represented by Deborah G. Weston.

United States District Court for the Southern District of West Virginia case number: 2:12-cv-09110

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