Over the Christmas season, the Service Employees International Union, Advocates for Rights of Citizens with Developmental Disabilities (ARC), and the Puget Sound Alliance for Retired Americans sued the Secretary of the Department of Social and Health Services in US district court in Seattle. The subject? Cuts Governor Gregoire rolled out in her supplemental budget to deal with a $1.1 billion shortfall---a reduction in home care hours to Medicaid patients.

The health care advocates argue that across the board cuts are illegal because each patient deserves an individual evaluation. Additionally, they contend that reduction in home-care hours will force Medicaid recipients into an institutionalized care setting, which violates their rights under the Medicaid act, which mandates the "Freedom to choose between institutional or home-and-community-based services."

Since the cuts would take affect January 1, the plaintiffs, represented by MacDonald Hoague & Bayless, also filed for a temporary restraining order to prevent the cuts from going into effect before the case is decided. And according to plaintiffs, they expect a ruling on the restraining order this Friday.

The cuts are especially severe for those with developmental disabilities: "They have a risk of health and safety," said ARC Executive Director Sue Elliott. "They may not be able to take their medications as regularly, or call in for their meds."

And according to Sean Walsh, Home Care Program Manager with ElderHealth Northwest, it's dodgy both ethically and financially. "I mean it's counterproductive from both a human suffering standpoint---some of these people will lose their homes---and also from a cost standpoint to Medicaid."

The cost argument is this: when patients who are currently receiving home care get their coverage slashed, some of them will eventually move to skilled nursing homes and other (and unequivocally more expensive) forms of care."This happens when they fail at home: they fall, or their condition deteriorates, or their food is improperly prepared because they don't have someone there to help."

And he's backed up by a declaration filed before the court by an expert. Charles Reed filed a declaration with the plaintiffs as the former Deputy Secretary of the Washington State Social and Health Services and a widely recognized expert on aging and long term care. It says that cutting home care hours will (among other bad things) increase Medicaid costs.

From Reed's declaration:
In total, there are approximately 33,500 individuals in Washington State receiving in home long term care services that likely will be severely impacted by the reduction of in-home service hours. This is likely to have a negative impact on the budget. The average cost to the State of Washington to serve a long-term care consumer in a Nursing home is $4,100 per month. The average cost to the State of Washington for an in-home client is $1,443 per month. Therefore, it costs about 65% less to serve an in-home client in their home.

According to Elliott, the plaintiffs' attorney has told them to expect a ruling on the restraining order by 31 December. If the restraining order is granted, it seems to this untrained legal observer to be a good sign that the cuts could be in trouble.

Which, I suppose, means the supplemental budget could be in trouble?
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