Medicaid Home Care Cuts Halted by Court

Legal challenge for those receiving “at home” care via Medicaid are growing across the country. Medicaid is a joint federal and state program that provides long-term care to the poor and disabled. This is distinguished from Medicare which provides general medical insurance for seniors. When prolonged nursing home visits or caregiving duties at home are needed it is Medicaid, not Medicare, that residents turn to when they cannot afford the services on their own.

Yet, it is no secret that budgets–both state and federal–are quite tight. Medicaid outlays are one of the largest single lines in those budgets, and so long-term financial plans almost always include mention of cuts to these services. Those who rely on Medicaid obviously have legitimate concerns about what this might mean in their specific case. At the end of the day, changes can be mandated both by state officials and the federal government. Each state may take a different track, and so it is important for local residents–when hearing news about proposed Medicaid changes–to understand if the proposal is coming from Illinois, the federal government, or another state altogether.

Legal Challenges
While both state and federal officials can alter program details, there are limits on what can be done. Specifically, the federal government usually provides funds to each state under the assumption that rules it creates will be followed by those states. The program rules provide flexibility to the states, but they also act as limits ensuring the goals outlined by federal officials is still carried out across the country. When a state makes a change in the programs that might violate the rules set forth by federal officials, then a lawsuit might be appropriate.

That appears to be the case in New York.

According to a New York Times story last week, a preliminary junction has been issued by a judge on threatened cutbacks to that state’s Medicaid coverage. The main issue was whether the state violated federal law when cutting back on personal care for certain community members on Medicaid. Certain residents who received two at-home care workers (on 12 hours shifts) would instead only receive one aide (who lived with the disabled resident).

The preliminary injunction officially stops the cut-back, but it does not officials decide the matter. In issuing the preliminary injunction, the court simply determined that the plaintiffs had a “substantial likelihood” of succeeding in their case–it didn’t actually decide the case.

In issuing the ruling, the judge felt that the evidence was strong against illegal termination of services. Apparently, proper notice was not provided to the residents affected and there were confusing interpretations of Medicaid rules which spurred the cuts to begin with.

The judge noted that financial pressures were likely the cause of the state agency’s decision to cut back on personal services. Yet, the judge’s ruling is a reminder that major changes cannot contravene the law. Of course, the law can be changed by relevant policymakers. But, until that occurs, state officials have to abide by the rules on the books and provide the care required and mandated.

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