Disabled sue South Carolina over Medicaid cuts

Because my local newspaper is attempting to make me pay for news (((laughs ruefully!))), it has been far more difficult than usual to get the required information to blog decently about this sordid state of affairs, but hopefully, this is complete enough for now.

I got this from the Myrtle Beach Sun--although it was originally published in the Greenville News. (cheapskates! greedheads!)

Disabled sue state over Medicaid cuts
By Eric Connor
The Greenville News

Lawyers for a group of disabled people are suing the state over its move to cut benefits for those who rely on government-funded home care, a decision they say violates the patients' civil rights and threatens to force people into institutions who don't belong in them.

On Tuesday, lawyers for the group and for the state will argue in U.S. District Court in Greenville over whether a preliminary injunction should be granted preventing state agencies from limiting the federal Medicaid funding the patients receive for community-based care.

The agencies responsible for administering the care - the Department of Health and Human Services and the Department of Disabilities and Special Needs - argue that tough economic times require cuts in services and that other options to prevent institutionalization are available.

Several Upstate residents with mental disabilities have sued the governor and two state agencies in Greenville federal court over controversial cuts to their in-home care, claiming the devastating reductions are forcing people into institutions in violation of federal law.

The residents, identified by first name and last initial, allege in the suit that Gov. Mark Sanford and the state Department of Disabilities and Special Needs, as well as the agency that administers its Medicaid programs, have discriminated against them by cutting off their social life and causing their isolation in residential facilities that will ultimately cost more taxpayer money.
DDSN spokeswoman Lois Park Mole and Sanford spokesman Ben Fox said they couldn't comment on pending litigation.

A North Carolina advocacy group argues a state agency's plans with personal care service benefits would violate the rights of patients and discourage them from independent living.

Disability Rights North Carolina wrote to federal Medicaid regulators asking them to reject proposals by the state Department of Health and Human Services and to the U.S. Justice Department asking it ensure the state complies with federal law.

A plan approved by the Legislature directs health officials to replace programs that give recipients living at home help bathing, cooking and other needs. Group executive director Vicki Smith wrote last week more than 20,000 patients could lose their services without appeals

Families of the disabled across South Carolina are carrying an added burden, facing with considerable fear the prospect that lifelines they have come to depend on will be cut in state government's deep reduction in services.

And they are concerned about government secrecy and that the agency largely responsible for controlling how they live their lives goes through an open process of deliberation with full transparency.

"There are a lot of us that are going to be right on top of them constantly to make sure that these things get out in public," said Greenville resident Leanne Hopkins, who has a son with cerebral palsy.

Scores of people convicted of crimes such as rape, elder abuse and assault with a deadly weapon are permitted to care for some of California's most vulnerable residents as part of the government's home health aide program.

Data provided by state officials show that at least 210 workers and applicants flagged by investigators as unsuitable to work in the program will nonetheless be allowed to keep their jobs or begin employment.

State and county investigators have not reported many whose backgrounds include violent crimes because the rules of the program, as interpreted by a judge earlier this year, permit felons to work as home care aides. Thousands of current workers have had no background checks.

The state's troubled mental health system faced another setback Monday when an advocate for the mentally ill named last week to run the agency withdrew from the post due to a flap over some tax problems at the group he ran.

John Tote, who until recently was the executive director of the Mental Health Association in North Carolina, and Health and Human Services Secretary Lanier Cansler announced that he won't become the next state mental health director. Tote's departure came on the same day he was slated to report to work for the state. Cansler and Tote said public discussion about payroll tax issues was too distracting at a time when the focus needs to be on helping patients and their families.

Gov. Mark Sanford has also been sued, but he has argued that he doesn't have direct control over the allocation of funds.

In court filings, the three Upstate plaintiffs allege that the DDSN claimed to suffer budget shortfalls but in fact had a $7.8 million "excess funds" account and used $2.6 million to buy real estate for support agencies in West Columbia and in Beaufort and Horry counties.

In addition, plaintiffs' attorney Patricia Harrison argues in court filings that talks about cutting services first occurred in 2008, when a budget crisis existed.

However, the federal government in February 2009 provided more than $195 million in stimulus funding to prop up Medicaid services, Harrison wrote, and when the decision to cut home-care services was made the DDSN was holding $34 million in stimulus funds and paid $30 million of it into a "rainy day" fund."

Also, Harrison wrote, the cost of providing home care to disabled people costs less than putting their care in the hands of an institution - $320 per day in an institution, $138 per day for home care.

The cuts - which are manifested in the form of a cap on the number of hours of home care a person can receive - will result in four times the amount of home-care patients being admitted into institutions, she wrote.

A lawyer for the state agencies, Kenneth Woodington, told a judge in court filings that lawyers didn't intend to file a response to the plaintiffs' "vast majority of new claims" but would do so if the judge wanted in relation to the injunction.

U.S. Magistrate Bruce Hendricks ordered that the hearing should particularly focus on whether the plaintiffs could suffer irreparable harm if services are cut.

One man in the original complaint against the agencies suffers from cerebral palsy and can only move by way of a wheelchair operated by his mouth, according to court filings.

On a given day, it can take from 8 a.m. until noon to get him out of bed, groomed and prepared to move, according to court filings.

The federal government's Medicaid program allows for a waiver so that funds that would have been used to care for a disabled person in an institution can be applied to caring for the person in a home or community setting, according to court filings.

The state is responsible for determining, through medical professionals, whether a person would benefit more from being cared for from home, according to filings.

A cut in services, Harrison wrote in her motion, would likely have the man leave behind a life as a productive member of the community and instead have him "forced to sit in an assigned seat around a table in a SCDDSN workshop with persons who have mental retardation, where the revenue from his labor will be paid to SCDDSN."

The man "lives in absolute terror of his worst nightmare coming true - being forced out of his home and moved into a congregate residence in order to receive the care he requires," Harrison wrote.

The services the man has been receiving during 2010 cost about $39,424, Harrison wrote, while institution-based services would cost about $116,000 a year.

In another case, a woman suffering from severe mental retardation is unable to speak and is subject to outbursts that put pressure on caregivers who aren't accustomed to her behavior, Harrison wrote.

The woman was once housed in an institution in Laurens County but was removed after she received unexplainable physical injuries, Harrison wrote.

The federal government's American with Disabilities Act requires that disabled people not be discriminated against and segregated from society, Harrison wrote.

"The right of persons who have mental retardation and related disabilities to live, work and play alongside their non-disabled neighbors, friends and family is no less important a civil right than the right of children of all races to attend integrated public schools," she wrote.

Attorneys for the agencies argue that the plaintiffs haven't proven that they would have to enter institutions with some cuts in their home services and in fact have other options they haven't explored.

"These plaintiffs argue that if they are not offered the richest items on the menu, they will starve," Woodington wrote. "In fact, however, there are many other possible services that could fill any gaps left by the reductions in their services, which are relatively minor in any event."

In court filings, Woodington argues that states are in compliance with the ADA if individual considerations could hurt the care of a larger population.

"The immediate relief for the plaintiffs would be inequitable," he wrote, "given the responsibility the state has undertaken for the care and treatment of a large and diverse population of persons with mental disabilities."

This is a pretty shoddy situation and I am curious what our new Wonder-Gal, the Governor-in-Waiting, Nikki Haley, has to say about it.

(Never mind, I can guess.)