Sep 24, 2011

People on Wait LIst Can Sue Florida Over Delays

Medicaid Patients Can Sue Florida Over Delays

(CN) - Medicaid-eligible patients with developmental disabilities may sue Florida for limiting their enrollment in the state's home and community-based care waiver program and putting them on a wait list, sometimes for years, a federal judge ruled in Tallahassee.
Home and community-based care has become a preferred alternative to long-term institutional care. Florida's Medicaid-funded waiver program allows developmentally disabled people to receive state services for less than the cost of institutional care, reintegrating patients with their communities and families.
The plaintiffs, on behalf of thousands of developmentally disabled Floridians eligible for Medicaid, accused Florida of mismanaging its Home and Community Based Services Waiver Program.
They claimed that due to Florida's lengthy waitlist and limited funding of the waiver program, some institutionalized patients are never enrolled or must wait more than 5 years to get into the program.
They sued the state, alleging violations of the Social Security Act, the Americans with Disabilities Act, the Rehabilitation Act and the 14th Amendment.
Lead plaintiff Joanna Dykes said that since Florida participates in Medicaid, it is required to provide Medicaid services "with reasonable promptness to all individuals." The class claimed that the "reasonable promptness" requirement applied to the waiver program as much as it applied to other Medicaid services, and that Florida's waitlist for the waiver was unlawful.
The class said Florida failed to meet the "freedom of choice requirement," which mandates that states inform eligible patients of alternative care available under the waiver.
Florida claims that Medicaid allows the federal government to limit the number of people eligible to receive waiver services, and the reasonable promptness and choice counseling requirements apply only when there are slots available in the program.
Taking into account the plaintiffs' claim that the waiver program has unfilled slots, U.S. District Judge Richard Smoak declined to rule on the reasonable promptness and the "freedom of choice" claims, finding that more data about enrollment in the program was needed to decide whether the state had met the two requirements.
The plaintiffs also claimed they had been denied due process when they were placed on the waiver waitlist without notice or an opportunity to be heard.
Smoak found the question of slot availability equally important in deciding whether Florida had violated the due process provision of the Medicaid Act.
The judge declined to rule on the ADA and Rehabilitation Act claims, but found that the plaintiffs had a private right of action under federal law. He denied Florida's motion to dismiss.