Judge halts change to Medicaid

lbonner@newsobserver.comDecember 9, 2011 

A federal judge has stopped the state from ending services for some Medicaid recipients who receive in-home care.

The decision is a victory for elderly and disabled people who need personal care services. But it will likely dip the state's Medicaid budget, already short $139 million, deeper into red ink.

The state Department of Health and Human Services said it would appeal the ruling.

The state had increased eligibility requirements for personal care services, so that to qualify recipients would need limited help with three "activities of daily living" such as bathing, dressing and eating, rather than two.

About a dozen residents sued in federal court to stop the cut, arguing the state was violating the federal law by setting higher standards for Medicaid recipients receiving care in their homes than it did for people living in adult care homes. U.S. District Court Judge Terrence W. Boyle granted an injunction Wednesday that stopped the state from using the new rules.

"This is good news," said Vicki Smith, executive director of Disability Rights North Carolina, one of the groups representing in-home care recipients. "This is a minimum level of service that will make a concrete difference for these individuals and their families."

The decision, however, could put another ding in the state's Medicaid budget.

The DHHS "continues to be concerned that unless the General Assembly acts soon to address the broader Medicaid shortfall, this essential optional service - and all others - could be eliminated," spokeswoman Renee McCoy said in a written statement.

The state and the personal care industry have been in a tug-of-war for years over program requirements and costs, with state officials and some legislators saying they needed to focus services on people who need them most, while the industry and recipients argued the state was cutting indiscriminately.

The in-home care cuts were in the 2010 budget with a projected savings of about $50 million. Services were to end for about 18,000 people.

Smith said DHHS has been working over the last few years to stem fraud and misuse. Only 2,000 or 3,000 people would be affected by the ruling, she said.

Attorneys representing DHHS argued that Medicaid money was short, but Smith said offering personal care will save money over time. It's less expensive for the government to pay for personal care for people living in their own homes than it is for 24-hour supervision in adult care homes, she said.

Bonner: 919-829-4821

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