Medicaid program caps questioned in Florida

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Florida fails to provide community based services for Medicaid-eligible individuals with spinal cord injuries at risk of institutionalization, according to a lawsuit filed in August in the U.S. District Court for the Southern District of Florida.

Under Florida law, the two plaintiffs, both of whom have quadriplegia, would be required to enter an institution before receiving funding through the state’s Traumatic Brain Injury/Spinal Cord Injury. The program is capped at 375 people through 2012, resulting in a substantial waiting list.

The two individuals require substantial care. According to an amicus brief filed by the Justice Department in September, one of the individuals has been hospitalized several times in 2010 and has “fallen out of his wheelchair and has had to lie on the floor for hours at a time.”

The lawsuit includes a request for a preliminary injunction, arguing that placement in an institution would create “irreparable harm” for the plaintiffs.

The state argues that it doesn’t have funding for the program because the state’s available money is already allocated to different funding sources, a distinction which the Justice Department argues doesn’t carry legal merit.

The amicus brief also disagrees with the state’s “fundamental alteration” defense that it can’t provide these services because it would fundamentally change how the state provides services to people with disabilities, an exception written in the Supreme Court’s 1999 Olmstead decision, which requires states to provide services for people with disabilities to live in the most integrated setting according to their needs. The brief argues that the save would save money by placing the plaintiffs in community homes, highlighting that it would cost $6,000 a month to place one of the plaintiffs in a nursing home and just $2,500 for home-based services.

A trial is set for June 2011.