The U.S. Court of Appeals for the 9th Circuit heard a case in June challenging a California plan to save $82 million from its massive budget deficit by sharply curtailing home-based services for more than 100,000 people with disabilities.
The U.S. District Court for the Northern District of California granted a preliminary injunction to halt the plan in October 2009.
Under the plan, the state of California would have cut an estimated 130,000 low income individuals and seniors, based on their ranking in the state’s Functional Index Score system.
Since 1988, as part of the ranking system, home health providers in California have been required to rank their patients on a scale of one to five in 14 daily activities. Under the proposed plan, California would have cut services to almost 40,000 individuals because their composite scores are below two.
Home health providers would also no longer have been obligated, or paid, to provide services for all daily activities where the patient scored below four. As a result, more than 90,000 patients would no longer receive basic services such as meal preparation, food shopping and laundry.
In the complaint, the plaintiffs argue that the Functional Index Score “was not designed to determine eligibility, has never been used for such purpose, and is not a reasonable measure of need or eligibility.” They argue the plan would disproportionately affect people with cognitive and psychiatric disabilities, as opposed to physical disabilities, because the activities that challenge them are reduced in emphasis in the scoring system. They also claim the system would disproportionately harm children because they automatically receive a score of one in four of the 14 categories in the scoring system.
In district court, the judge stated the plan’s implementation would have caused “irreparable injury” because people with disabilities “will be deprived of critical health-related services and subjected to imminent risk of out-of-home placement, institutionalization and/or harm to their health and safety.”
The Supreme Court ruled in its 1999 Olmstead decision that states are obligated to provide services to eliminate cases of unnecessary institutionalization.
The Medicaid Act also requires prior notification and a chance to challenge reductions in Medicaid services. This requirement, the plaintiffs allege, would not have been satisfied by the state’s plan to notify Medicaid patients 10 days prior to the day the plan was originally supposed to go into effect.
The lawsuit, on behalf of five people with disabilities, was filed by Disability Rights California, the Disability Rights Legal Center, National Senior Citizens Law Center and the National Health Law Program. The Justice Department also filed an amicus brief.
Disability Rights California is part of the federally funded protection and advocacy system and a member of the National Disability Rights Network.