Disabled people in Louisiana file class action lawsuit over state's planned cuts of home-care Medicaid services

From Courthouse News Service:

BATON ROUGE, La. -- Louisiana wants to cut home-care Medicaid services for nearly 11,000 severely disabled poor people and institutionalize them, a class action claims in Federal Court.

Louisiana faces a $1.6 billion budget deficit. Like many states, it is trying to slash spending, but similar class actions in other states have pointed out that institutionalizing disabled people will cost the states more in the long run.

More than 80 percent of Louisiana's Medicaid money comes from the federal government, and if the state accepts the money, it must comply with federal rules, the class claims.

If the Medicaid-funded program in question is changed, as the state has requested, disabled care will fall to nursing facilities and other state-run institutions.

The four named plaintiffs range in age from 30 and 78 and suffer from severe chronic conditions, including paralysis, stroke, chronic heart failure and multiple sclerosis.

"None of them wants to leave their homes, friends, and families and to go into a nursing home in order to receive the same Medicaid-funded services that they presently receive in the community," the complaint states. "They are all at risk of institutionalization if their Long Term-Personal Care Services are reduced and capped, as the defendants propose."

The plaintiffs have been receiving home-care assistance through the Medicaid-funded Long Term-Personal Care Services Program. The assistance, which includes bathing, dressing, eating, bowel and bladder care, meal preparation and clean-up, shopping, and laundry, has kept the plaintiffs in their homes and communities.

Plaintiff Rickii Ainey, 30, has been disabled her whole life with congenital arthritis that has paralyzed her from the waist up. She lives alone in New Orleans and needs assistance with all activities of daily living. She cannot prepare meals or shop without assistance.

According to the complaint, Ainey's "mother lives nearby but refuses to assist her daughter. Ms. Ainey has a sister who lives in Arkansas and four brothers who live in New Orleans. Her brothers cannot provide the intimate personal care she needs, and Ms. Ainey does not believe they are responsible enough to help her on a regular basis.

"Ms. Ainey attempted suicide in December of 2006. The primary reason for the suicide attempt was the fact that she had no personal care assistance."

Under the Americans with Disabilities Act, "institutionalization and segregation are prohibited forms of discrimination against individuals with disabilities," the complaint states.

"The ADA therefore requires that a public entity administer its services, programs and activities in the 'most integrated setting appropriate' to the needs of qualified individuals with disabilities."

Due to its projected $1.6 billion budget deficit, every department of state government, including public universities, has been asked to review its budget and trim it by 35 percent, according to press reports.

But the state Medicaid program receives federal dollars and must comply with federal regulation. "Federal Medicaid funds make up 81.48 percent of Louisiana Medicaid payments," according to the complaint.

"States are not required to participate in the Medicaid program, but if they do so, they must operate their programs within federal statutory and regulatory provisions. They must adopt a state plan that delineates the standards for determining eligibility and identifies the extent of Medicaid benefits. ..."

"Nationally, the mean number of hours of personal assistance services that persons who require assistance for four ADLs receive per week is 85.9 hours." (ADLS are Activities of Daily Living: eating, using the toilet, moving, and moving around in bed.)

Until this past March, the maximum amount of care a disabled person in Louisiana could receive was 56 hours per week. After March, that number dropped to 42 hours.

In August, the Louisiana Department of Health and Hospitals "announced that it was again changing the method of deciding the number of hours allocated and reducing the maximum numbers of hours of ... service that recipients could receive, from 42 to 32 hours per week," the complaint states.

"The proposed class consists of Louisiana residents with disabilities who are recipients or prospective recipients of Medicaid-funded services through the LT-PCS program; who desire to continue to reside in the community instead of in a nursing facility; who can reside in the community with appropriate Medicaid-funded LT-PCS services; and who are at risk of being forced to enter a nursing home because defendants plan to reduce the level of community-based services."

As of April this year, the Louisiana Department of Health and Hospitals reported there were 10,878 people statewide receiving Medicaid LT-PCS services.

The class seeks wants the reduction of services proposed by the Louisiana Department of Health and Hospitals under Secretary Bruce Greenstein enjoined as violations of the Americans with Disabilities Act and the Medicaid Act.

The class is represented by Nell Hahn of Lafayette.