Eye On Boise

Medicaid lawsuit seeks class-action status

A group of Medicaid patients with severe disabilities who sued the state last year over cuts in their care are now seeking class-action status for their lawsuit, on behalf of about 3,600 people who receive care through a waiver program for people with developmental disabilities. The AP reports that a federal judge already had ordered the state to reinstate the plaintiffs' benefits or make other changes, but the plaintiffs said the state made the changes only for the 13 plaintiffs, and continued to follow its disputed practices for everyone else on the program.

If the judge agrees to make the case a class-action lawsuit and restore the coverage to all 3,600 patients, the state could have to spend $3.1 million more on the program in state dollars, and more than $10 million when the federal match is added in; click below for a full report from AP reporter Rebecca Boone. All of the plaintiffs have multiple medical or mental health problems or developmental disabilities, and all of them need supervision. Some require 24-hour care.

Group asks to make Medicaid lawsuit class-action
By REBECCA BOONE, Associated Press

BOISE, Idaho (AP) — Thirteen severely disabled residents who sued the state last year after their Medicaid budgets were dramatically cut are asking a federal judge to make the case a class-action lawsuit on behalf of the roughly 3,600 people who receive medical care through Idaho's Developmentally Disabled Medicaid Wavier program.

A judge already had ordered the state to either restore the plaintiffs' Medicaid budgets or fix the process it uses to notify them of cuts while the lawsuit proceeds.

But Ritchie Eppink, an attorney with the ACLU of Idaho who is representing the group, said he requested class-action status because the Department of Health and Welfare was still using the old notification process for everyone else in the program.

"What the department has done instead is to try to wiggle out by saying, 'OK, we won't send these faulty notices out to your clients, but we will send them out to everyone else in the program," Eppink said.

If the judge agrees to make the case a class-action and stop the budget cuts while it moves forward, the state could be forced restore the budget back to 2011 levels. That's an increase of roughly $3.1 million in state dollars, and more than $10 million when the federal match is added in.

All of the plaintiffs have multiple medical or mental health problems or developmental disabilities, and all of them need supervision. Some require 24-hour care.

Normally, the state assigns those clients an "individual budget" for the year, which is essentially a cap on how much each client may spend on medical needs or other care. But the plaintiffs say that in 2011, their budgets were cut dramatically, leaving them without enough funds to get the care they need. They also say the state doesn't give clients adequate notice of the cuts or how they can appeal the decisions.

The plaintiffs say that because the state refuses to reveal the method it uses to set the budget, it's nearly impossible to fight the decision.

Those recipients who do file an appeal with the state must argue their case before a hearing officer who is hired and paid for by the Idaho Department of Health and Welfare, and the plaintiffs say that means the hearing officers have a built-in bias in favor of the state.

The Idaho Department of Health and Welfare has maintained that the formula for computing the budgets is a trade secret.

Health and Welfare spokesman Tom Shanahan said the department's attorneys were still reviewing the motion for a class action and so were not ready to comment. But Shanahan also said that sometimes individual budgets are cut because the client doesn't use all the money they were budgeted the previous year. For instance, if a recipient was budgeted $50,000 but only spent $45,000 on services, the next year they could likely expect to see their new budget set at $45,000.

Still, he acknowledged the department has faced steep cuts since the economic downturn, including cuts to Medicaid. Those cuts have been the subject of multiple lawsuits in recent years, from recipients, their legal guardians and the health care businesses that serve residents with severe developmental disabilities.

The state has not yet issued its response to Eppink's class-action request, and it could be months before a judge issues a decision on the matter.


Copyright 2013 The Associated Press.




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Betsy Z. Russell
Betsy Russell covers Idaho news from the state capitol in Boise and writes the Eye on Boise blog.

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