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Great Home Care decision in AZ

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    Great Home Care decision in AZ

    Judge Orders Arizona to Raise Home Care Pay Rates
    A federal district judge has ruled that Arizona must raise wages for attendant care workers and personal care workers in order to ensure that
    Medicaid beneficiaries receive the home- and community-based services they are entitled to.

    The Court's decision in Ball v. Biedess follows four and a half years of litigation in a statewide class action lawsuit on behalf of a group of elderly and disabled Medicaid recipients. The suit was brought against the
    Arizona Health Care Cost Containment System (AHCCCS), which administers the state's Medicaid programs, by lawyers from the Arizona Center for Disability Law, AARP Foundation Litigation, and DNA Peoples Legal Services.

    The plaintiffs are Medicaid long-term care recipients who are legally entitled to home-based attendant care, personal care, homemaker services and respite services, but have been unable to obtain some or all of the services they qualified for. Their lawyers argued that there are too few home care workers available to supply the authorized services, largely because the workers employed in the state's Medicaid system in 1999 typically earned between $6.50 and $8.50 an hour, while those who worked for private paying clients typically earned between $10 and $12.

    "This case started years ago," notes Jane Perkins, legal director for the National Health Law Program. "There was a lot of testimony and minutiae to it, but when you read the decision, it's really quite straightforward. The judge said: Here's what Medicaid home care workers are getting paid, here's what privately paid home care workers are getting paid. There's a big
    difference. We have evidence to show that when people are getting paid more, the supply of these providers increases."

    The decision, which was released this Tuesday, is "very significant," according to Perkins, in part because "it acknowledges that if a state is
    going to participate in Medicaid, it has to live up to all parts of the bargain, and one those parts is that rates be sufficient to ensure that
    services are available."

    The plaintiffs, who entered the courtroom on gurneys and in wheelchairs to testify, clearly made an impression on U.S. District Court Judge Earl Carroll. "Each of them testified to being trapped in bed unable to change position or care for personal hygiene, abandoned for hours in a bathroom, left without food or water, or similar experiences, due to the lack or absence of health care providers," he wrote in a footnote to his decision.
    "It is the intent of the Court to do whatever is available to prevent any AHCCCS recipients from experiencing the kind of frustration, embarrassment,
    and discomfort experienced by the representative class members of this class action."

    In his decision, Judge Carroll found evidence of "multiple studies and reports [which] indicated a shortage of attendant care workers in Arizona"
    and of "difficulty recruiting attendant care workers due to low wages." He also relied on reports and testimony from expert witness Dorie Seavey, a labor economist and national policy specialist for the Paraprofessional
    Healthcare Institute, quoting her testimony that payment rates for home health workers are too low to attract the number of workers needed. Judge
    Carroll also cited Dr. Seavey's testimony that "[t]here is serious evidence that there are people who have care hours authorized who are not receiving them and that there are not methods and procedures in place to measure that gap in services."

    The judge ruled that AHCCCS "failed to provide the representative class members with the equal access, quality of care, and freedom of choice to
    which they are entitled." He ordered the agency to raise payment rates to workers (referred to in the decision as "providers") to levels that attract the needed candidates. In addition, he ordered the state to develop systems to monitor and report gaps in service, and to eliminate any gap reported by a recipient within four hours.

    "That's a very systemic approach," says Elizabeth Priaulx, senior disability legal specialist for the National Association of Protection and Advocacy Services, "and it's written with a respect for the professionalism of providers."

    Perkins thinks the Court's decision could serve as a blueprint for other states. "The decision here envisions a process for getting this situation addressed in a timely way," she says. "If what the court envisions occurs, then that's the kind of thing that I think other states will latch onto. They're looking for what works."

    According to Sally Hart of the Arizona Center for Disability Law, a lead attorney for the plaintiffs, the decision is significant partly because "it identifies wages as a problem in securing services for people who are entitled to home- and community-based services, and it orders the state to ensure that wages are adequate. The state had argued for years that the problem in securing an adequate and a good workforce had nothing to do with lack of wages or benefits."

    What's more, says Hart, the state had argued that it was not responsible for setting pay rates for home care providers after converting its Medicaid
    program to managed care several years ago. Instead, the state said, it was up to the agencies it contracted with to set those rates. Judge Carroll disagreed, saying it was AHCCCS's responsibility to offer a rate of pay high
    enough "to attract enough health care workers to deliver all of the services for which an individual qualifies."

    Judge Carroll has ordered the parties involved in the lawsuit to present him with a timetable for implementing his orders by September 30. However, Hart notes, the state is likely to appeal the decision.

    Meanwhile, advocates for Medicaid beneficiaries nationwide are lauding the ruling. "Across the country, people remain inappropriately institutionalized simply because there are not sufficient community-based providers," says
    Priaulx. "The [Arizona District] Court recognizes the states' obligation to provide rates that are sufficient to actually attract enough providers."

    To read the decision, go to http://www.directcareclearinghouse.o...lvsBiedess.pdf

    "All you have to decide is what to do with the time that is given you."
    Gandolf the Gray

    2010 SCINet Clinical Trial Support Squad Member

    "You kids and your cures, why back when I was injured they gave us a wheelchair and that's the way it was and we liked it!" Grumpy Old Man

    .."i used to be able to goof around so much because i knew Superman had my back. now all i've got is his example -- and that's gonna have to be enough."

    Interesting that the case is in Arizona, in light of the Time magazine article about the border problems there (illegals entering the US). I wonder if the presence of illegals is making provider companies think they can keep wages low, or just if the state has such a drain on public services because of the illegals. It may not be at all related, it's just interesting to me since I just read the Time article too.

    AB wife of T8 complete para
    AB wife of T8 complete para


      Unfortunately there is so much disarray between CMS (Federal) and State Medicaid programs. Just don't understand "why" and have pondered this in my head so often. Funny, the whole goal of states Medicaid Waiver programs is to promote independence. I believe this is "true" of sorts but generally only "within" the spider web of that states governing body, but the minute you get off statefunded assistance, you are on a parachute ride. Advocacy at the state level is so important for those seeking improvement of state funded programs. This case is one of many examples. Nice post Leo.