Louisiana Can’t Nix Suit Over Home-Care Cuts

     BATON ROUGE (CN) – A federal judge has ushered forward a lawsuit that accuses Louisiana of forcing disabled individuals into institutions by cutting Medicaid funding for home care, a federal judge ruled.




     U.S. District Judge James J. Brady ruled against summary judgment for the state Department of Health and Hospitals in a lawsuit filed by four named plaintiffs last fall on behalf of a class that says 11,000 severely disabled poor people will be forced into institutions by recent dramatic cuts in Louisiana’s budget for Medicaid funded home-care.
     In March 2009, in order to address budget concerns, the state lowered the maximum weekly disability program home-care hours that a person could receive from 56 to 42.
     Just six months later, in September 2010, the state again lowered the maximum weekly service hours, this time from 42 to 32.
     Nationally, individuals who require in-home assistance through state Medicaid programs receive an average of from between 59.6 and 85.9 hours of assistance, according to a footnote on the court document.
     The Louisiana Department of Health and Hospitals has determined the change in allowable home-care hours will save the state $5 million in 2011 and $24 million in 2012.
     But the plaintiffs say that the average cost of services for individuals in the state’s disability services program are less than it would cost to keep an individual in a nursing home. The plaintiffs also say the cost of nursing homes has steadily increased over the last few years.
     The judge found that the state’s drastic cuts to in-home services are both in violation of the Americans with Disabilities Act (ADA) and unlikely to save the state any money in the long run, as leaving severely disabled people with no choice but to move into institutions that are more expensive than the state is willing to pay for home-care services will drive Medicaid expenses back up, ultimately negating any short-term savings.
     Since the 11,000 disabled people who currently receive in-home services want to be at home, as opposed to in nursing facilities, cutting in-home care so drastically as to force the severely disabled into institutions is a very clear violation of the ADA, the judge ruled. “A state’s program violates the ADA’s integration mandate if it creates the risk of segregation; neither present nor inevitable segregation is required.”
     In his decision, Brady wrote that since the plaintiffs clearly require at least 39 hours of home-based care per week, Louisiana’s current home-based care plan would require plaintiffs to receive, on average, seven more hours of care per week than the state currently allows.
     The state has a long waiting list for individuals wanting home-based care. One way to make it to the top of the list is to spend 120 days in a nursing facility, “however, this would subject plaintiffs to the very institutionalization which the ADA seeks to avoid. Therefore, the state’s current plan plainly violates the ADA by creating a greater risk for institutionalization for those individuals who require more than 32 hours per week of assistance,” the judge wrote.
     The court additionally found summary judgment for the Department of Health and Hospitals is not appropriate because the average cost of providing home-based care is less than the cost of maintaining an individual in a nursing facility, so forcing people who currently live at home to move into institutions that cost more than the state is willing to pay for home-care services won’t ultimately result in any savings to the state.

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