Thirteen disabled Idahoans, living with disabling and chronic conditions such as epilepsy, muscular dystrophy, Down’s Syndrome, schizophrenia, and developmental disabilities ranging from mild to severe, are suing the Idaho Department of Health and Welfare (IDHW) over cuts to their Medicaid benefits that IDHW refuses to explain.

 

The issue is how IDHW calculates their annual health care budgets. For example, plaintiff “C.M.” (the lawsuit names the plaintiffs only by their initials) is a 53-year-old woman with muscular dystrophy who has lost an eye, has a history of heart problems, and is unable to evacuate on her own in an emergency or administer her medications without help. She requires 24-hour attendance, yet in 2010 IDHW assigned her a health care budget of only $53,119.69, which was nearly doubled, to $105,500, when she appealed the amount. Nevertheless, in 2011 IDHW again cut her budget, this time by 21% to $82,576.32. Under her reduced budget, C.M. cannot afford the 24-hour assistance she needs, but IDHW has refused to provide any reason for the cut or how it was calculated, making it next to impossible for C.M. to challenge the decision. The situations of the other twelve plaintiffs are similar, with IDHW claiming that its budget calculation method is a “trade secret” it need not disclose.

 

As AllGov has reported, the Great Recession has caused state tax revenues to decline even as poverty rates and the number of persons eligible for Medicaid, which is jointly funded by state and federal government, have grown. Unable or unwilling to raise taxes to cover the shortfalls, state governments have been cutting benefits and tightening eligibility. The Idaho lawsuit argues that under both state and federal law, Medicaid patients have a right to know how their health care budgets have been calculated, so that they can challenge a number that is too low to pay for the care they need. The Medicaid Act requires the states to make their budget-setting methods “open to public inspection.” As the lawsuit was filed on January 18, 2012, the state of Idaho has not yet filed its answer, nor has it issued a public statement on the subject.

-Matt Bewig

 

What's the Big Secret? Disabled Ask State (By Philip A. Janquart, Courthouse News Service)