|
Volume 12 Number 88 News: Medicaid A Washington Medicaid regulation that reduces the amount of paid care for disabled residents living with caregivers violates federal law, the state's supreme court ruled May 3 (Jenkins v. Washington Department of Social and Health Services, Wash., No. 78652-6, 5/3/07). The Washington Supreme Court said that the Washington Department of Social and Health Services (DSHS) regulation, which reduces the number of hours of paid aid available to disabled individuals by 15 percent when they are in a "shared living" arrangement, was invalid because it violated the federal comparability requirements in 42 U.S.C. §1396. Agreeing with disabled individuals who filed consolidated appeals of state court rulings that found the regulation was invalid, the court said that the regulation ran afoul of the federal Medicaid requirements. Medicaid mandates that "the medical assistance a state provides for any categorically needy individual 'shall not be less in amount, duration, or scope' than the assistance provided to any other categorically needy individual,'" the court said. The court ruled that the state regulation, WAC 388-106-0130(3)(b), failed to ensure that there is parity in the provision of needed services as between individuals, and that an across-the-board reduction, without consideration of individual needs of specific recipients, was unreasonable. The court addressed the complaints of David Jenkins, Vennetta Gasper, and Tommye Myers, all of whom are functionally disabled individuals who receive from the state paid in-home personal care services to help them with basic activities of daily living such as bathing, dressing, shopping, housekeeping, and meal preparation, the court said. They challenged the shared living rule, one component of an assessment tool used by DSHS called "Comprehensive Assessment Reporting Evaluation" (CARE) used to determine an individual's eligibility for in-home care under one of four state programs, the court added. No Deference Owed The court began its analysis by rejecting the department's argument that its interpretation of the Medicaid law's comparability provision "because of its expertise in administering that law," was entitled to deference. "We reject this argument because the Medicaid comparability provision is specific in demonstrating Congress' intent to provide comparable services to similarly situated recipients," the court said. The court then considered the merits of the individuals' claims, noting that the individuals argued that DSHS "violates comparability when it allocates paid services using the presumption of the shared living rule, rather than an individualized determination of each recipient's need for paid services," it said. "In fact, DSHS has promulgated a rule where recipients like Jenkins, Gasper, and Myers will have certain needs unmet while others with comparable disabilities will receive adequate services," it added. "This is so because DSHS neither addresses nor evaluates the variation of individual situations where caregivers perform household tasks that may benefit both the recipient and the household generally," the court continued. "Without such an evaluation, DSHS cannot automatically reduce, in shared living situations, a recipient's need for assistance with housekeeping, shopping, meal preparation, and wood supply; rather, DSHS must assess those needs in the same way and to the same extent that services are provided to the meet the needs of other recipients who do not live in a shared living situation," it said. The court agreed that DSHS could use the CARE assessment program "to initially classify, rate, and determine a recipient's level of need because this process is consistent with the Medicaid program's purpose." It found the department violates the federal comparability requirement, however, "when it reduces a recipient's benefits based on a consideration other than the recipient's actual need." The 15 percent reduction "across the board for all recipients who live with their caregivers does not address, and in fact ignores, the realities of the recipients' individual situations," it added. "We conclude that no reduction is justified unless an individual determination is made supporting that reclassification. "Accordingly, we invalidate WAC 388-106-0130(3)(b) to the extent that it presumes certain needs of the recipient are met without an individualized determination, and, the presumption results in an automatic 15 percent reduction in the recipient's assessed number of allotted care hours based only on the fact that the recipient lives with a caregiver," it concluded. The court's decision is available. A dissent filed in the case is available.
|
