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Thursday, March 25, 2010

Ind. Decisions - Clay County woman wins Medicaid suit against state; More

Arthur Foulkes reports today in the Terre Haute Tribune Star:

A rural Clay County woman has defeated an attempt by the state government to limit home-care services for elderly and disabled people receiving Medicaid.

On March 8, Clay County Superior Court Judge J. Blaine Akers ruled in favor of Edna Chadwell of Carbon, who challenged the state’s recent effort to cap in-home Medicaid benefits.

“I was happy for myself and for the other people in the lawsuit,” Chadwell said Wednesday, sitting in the kitchen of her modest home. “I’d rather die than live in an institution.”

In 2008, the State of Indiana announced it was capping the maximum number of hours Medicaid – under a special waiver program – will cover in-home care for people with serious disabilities.

The cap was set at 40 hours per week for most types of care. Chadwell, who is confined to a wheelchair and can only move her arms with difficulty, was receiving in-home help 70 hours per week.

“It was scary at first” when the state announced the caps, Chadwell said. She requires help getting out of bed each morning and getting into bed each night, she said. She also needs a caregiver to prepare her meals, help her shower and even brush her teeth.

“I’m totally dependent,” Chadwell said. “Anything you can do for yourself, I need help with.”

Rather than accept the cut in her services, Chadwell, who has been diagnosed with cerebral palsy and quadriplegia, challenged the caps in Indiana’s courts. Soon, the American Civil Liberties Union of Indiana took her case, which came to include seven other disabled plaintiffs.

“Most of the … plaintiffs are confined to a wheelchair and all require significant assistance with nearly all of their activities of daily living,” Akers stated in his 39-page decision in the case. The other plaintiffs included people diagnosed with muscular dystrophy, traumatic brain injuries and multiple sclerosis.

The State of Indiana, which argued the waiver program was not required by federal law and, therefore, could be changed, could still appeal the decision, but ACLU attorney Gavin Rose, who argued the case for the plaintiffs, said Akers’ decision was very thorough and would be tough to overturn.

The caps, although in place for several months in 2008 before Akers ruled them suspended until the case was settled, temporarily affected dozens of Hoosiers on Medicaid. But they did not affect Chadwell or the other seven plaintiffs in the case, Rose said.

“The ACLU did a wonderful job … so I didn’t go without anything,” Chadwell said.

Of the approximately 100 Hoosiers affected by the caps, about one-third saw their weekly hours of Medicaid-provided in-home care reduced by fewer than 10 hours per week. Meanwhile, 40 people had their Medicaid-provided in-home services reduced under the caps by more than 31 hours per week, according to court documents.

The approximately 100 people affected by the caps made up fewer than 2 percent of the total number of people taking part in the Medicaid waiver program, the court documents state.

The State of Indiana did not argue that the in-home care caps were designed to save money, but Chadwell and Rose both believe that was the state’s main consideration. However, the “average costs for in-home services under Indiana’s Medicaid waiver program has been less than the comparable cost in a nursing home,” according to a report by Severns Associates, an Indianapolis law firm specializing in health care-related law. * * *

The victory in the case, officially Chadwell v. Indiana Family and Social Services Administration, is an important one, the ACLU’s Rose said. This will allow many disabled Hoosiers to remain in their homes close to friends and family “and not be pushed into a corner of some nursing home.”

Here is a copy of Clay County Superior Court Judge J. Blaine Akers' 39-page opinion.

More: Gavin Rose tells the ILB that the ACLU of Indiana also as a companion case (captioned B.N. v. Murphy) pending in the Northern District:

The legal claims in both are substantially identical—the difference is that Chadwell dealt with “attendant care services” and B.N. deals with “respite services” (which were also recently capped). The B.N. case is fully briefed on summary judgment and ripe for decision.
Here is a copy of the (amended) complaint in B.N. v. Murphy.

Posted by Marcia Oddi on March 25, 2010 09:44 AM
Posted to Ind. Trial Ct. Decisions