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The right to a fair hearing: Decision in Brooks v. Maryland Health Insurance Plan

July 18, 2011:  Unable to find health insurance because of his pre-existing health conditions, Mr. Brooks enrolled in the Maryland Health Insurance Plan (MHIP), a state-controlled “high-risk” pool that accepts enrollees who have been denied coverage by private insurers. Mr. Brooks challenged the scope of his prescription coverage in court and, soon after, the MHIP terminated his entire coverage, claiming that he was not a Maryland resident. Mr. Brooks appealed the termination, but he was never given an opportunity to formally present evidence of residency and the final decision maker was the very administrator who had made the initial termination decision. Not surprisingly, the termination decision was affirmed. 

On April 27, 2009, the Public Justice Center, joined by the American Cancer Society South Atlantic Division, American Cancer Society Cancer Action Network, Legal Aid Bureau, Inc., Maryland Disability Law Center, Medicaid Matters! Maryland, Maryland Disability Law Center, Homeless Persons Representation Project, Maryland Women’s Coalition for Health Care Reform, and Civil Advocacy Clinic of the University of Baltimore School of Law, filed a friend-of-the-court brief in Mr. Brooks’s case, Brooks v. Maryland Health Insurance Plan, in the Maryland Court of Special Appeals. The brief, authored by former Murnaghan Appellate Advocacy Fellow Matthew Hill, detailed the importance of MHIP enrollment to its members and argued for a full application of due process protections that were conspicuously absent from MHIP’s decision to terminate Mr. Brooks’ enrollment.
The Maryland Court of Special Appeals issued a favorable opinion on July 18, 2011, agreeing with the PJC’s argument that Mr. Brooks’s due process rights were violated by the MHIP’s termination decision. Specifically, the court held that Mr. Brooks was entitled to a full evidentiary hearing before an impartial decision maker regarding his membership eligibility. Unfortunately, the Court’s opinion is currently unpublished and thus does not act as precedent for other courts. The PJC hopes that the MHIP will respond to this decision by instituting a fair process for all future challenges to termination of coverage decisions. 

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