Thursday, December 31, 2009

Disabled Coloradoans sue over cuts to Medicaid benefits

From The Denver Post:

A group of disabled Coloradans who say their Medicaid benefits were cut without warning is suing the state, claiming the reductions strapped their budgets for in-home health care just before the holidays.

The complaint against the state Department of Health Care Policy and Financing is the second filed this month alleging the Medicaid program is treating disabled people unfairly.

The latest lawsuit isn't focused on the cuts in benefits — the entire Medicaid program was slammed with budget reductions this fall — but the lack of notice.

Up to 750 disabled residents rely on monthly Medicaid benefits to pay nurses and caregivers to help them bathe, dress, cook and take medications in their homes. They are enrolled in a program that lets them hire, fire and manage their own attendants instead of working through a home-health agency.

Some of those in the program received letters in October informing them of a 1.5 percent cut in their allocation — retroactive to Sept. 1 — without explanation or, they claim, legally required notice that they were allowed to appeal.

Other patients received no notification at all.

The lawsuit, which seeks to represent the whole class of Medicaid beneficiaries, alleges the cut was more than cuts levied on other people who receive home-health services.

Additional rate cuts came in December.

The state contracted with a new company to dispense payroll checks for nurses and caregivers working in the homes of Medicaid recipients, increasing the new company's cut to 11 percent of those Medicaid allocations instead of the previous 10 percent.

The extra 1 percent came out of beneficiaries' checks, this despite assurances last spring that the new contract would not affect services, according to the Colorado Cross-Disability Coalition, which is organizing the lawsuit.

Also, the state cut an additional 1 percent out of the Medicaid budget. Yet that December round of reductions for Medicaid beneficiaries in the home-health program varied widely — in some cases more than 4 percent.

"Nobody knows what that money is and where it's going," said Kevin Williams, an attorney for the coalition. "Well, somebody knows. But there is no explanation for it.

"What happened was just an unbelievable mess."

Officials with the state Medicaid department would not comment on the lawsuit but said rate cuts are made across the board for services — not set individually for beneficiaries.

"We can't discuss what's in the lawsuit," said department spokeswoman Joanne Lindsay.

The department's rate-reduction schedule shows a 1.5 percent cut Sept. 1 and an additional 1 percent cut Dec. 1.

It's unclear then why some disabled Medicaid clients were hit with cuts totaling up to almost 6 percent.

Among those patients is Julie Reiskin, who has multiple sclerosis and lives with two other disabled people.

"We help each other best we can, but I have a paid person come at least five days a week," she said.

Reiskin received a letter Oct. 13 informing her that her Medicaid benefits were reduced 1.5 percent — to $1,460.66 — retroactive to Sept. 1. A second letter Dec. 2 informed her of an additional reduction — a drop to $1,410.30 — effective Dec. 1.

The total cuts to her monthly benefits were more than 4 percent.

Even single-digit rate reductions are huge to disabled Medicaid patients, who often budget every penny of their allotment to pay for in-home help, Williams said.

The disability coalition also sued the state Medicaid department this month on behalf of a disabled woman denied increased in-home benefits after receiving a tracheotomy. The lawsuit claims the state wanted to put her in a nursing home rather than bump up her in-home care budget.

The Medicaid department also has been embroiled in a stalemate with the only two long-term health care facilities in Colorado that had accepted paralyzed patients on ventilators.

The two centers provide less expensive care than hospitals, but the state has cut reimbursement to the point where the centers lose money on each patient.

The program that allows disabled Medicaid patients to live at home — instead of in nursing homes — is designed to save money, but the cuts could actually force patients into nursing homes.

Some of the disabled people in home-based Medicaid programs "are expensive, but they would be more expensive elsewhere," Reiskin said. "At some point, as a society, we have to take a stand and say that people should have a right to be alive."