LOSS OF SERVICES ENDANGERS FRAGILE, ELDERLY PEOPLE WITH DISABILITIES; COURT TO HEAR CHALLENGE TO CUTS

Medicaid cuts affecting 8000 Californians with disabilities go into effect September 7, 2009

Linda Gaspard-Berry, a full-time hospital worker, and her brother, balance between them the round-the-clock care needed by their mother, 79 year-old Allie Jo Woodard.

Lillie Brantley, 84, and her grand-niece, Chauncey McLorin, a full-time MUNI driver, share McLorin’s home because Brantley cannot safely be left alone.

The key to keeping both these fragile women with serious disabilities out of nursing homes has been their 5-day-a-week participation in the Bayview Hunter’s Point Adult Day Health Care center. Here, Monday to Friday they are welcomed by medical and therapy staff who work with them individually to maintain the faculties they have and prevent hospitalization through close attention to their conditions.

As a result of the significant budget cuts, on September 7, Lillie Brantley, Allie Jo Woodard and 8000 other Californians whose disabilities, age and poverty qualified them for these critical services will be reduced from five to three days a week. Gaspard-Berry and McLorin are worried that their elderly relatives will be forced into nursing homes, because they cannot afford to give up their jobs to provide care. McLorin said that “placing my aunt in a home would be devastating for her and our family.”

Catherine Davis, Program Director for the Hunter’s Point center, noted that all of their approximately 100 clients are living at or below the poverty line and have complex medical needs.  Davis said they have worked hard to develop a program that is culturally sensitive and their client community is 85% African –American, 6% Asian and Pacific Islander, 5% Latino and 4% Caucasian.

Lawsuit successful in delaying cuts

After three elderly people with disabilities filed a lawsuit challenging the devastating cuts to Medi-Cal funded Adult Day Health Care (ADHC) services, the State agreed to delay the cuts in order to provide notice to affected recipients, which Plaintiffs argued is required by federal law.

In addition, on September 9, 2009, Judge Saundra Brown Armstrong will hear Plaintiffs’ Motion for a Preliminary Injunction in Brantley, et al. v. Maxwell-Jolly, Director of California Department of Health Care Services. ADHC provides daytime health and nursing care, therapies and other services to low-income seniors and people with disabilities.  Participants are approved by Medi-Cal to receive ADHC services in order to prevent hospitalization and institutionalization.

The class action lawsuit was filed on August 18 in federal district court in the Northern District of California.  Plaintiffs seek to enjoin the State from implementing one aspect of the cuts contained in ABx4 5, one of a number of bills enacted in response to California’s budget crisis.  Specifically, on September 7, the maximum number of days Medi-Cal will fund ADHC services for all participants will be reduced from five to three per week regardless of the seriousness of the participant’s health problems.  The reduction in days, if implemented, would place as many as 8000 recipients at immediate risk of institutionalization, hospitalization, injury or death.  The cuts were to take effect on August 27, but after Plaintiffs filed their lawsuit, the State agreed to delay the cuts until September 7 in order to distribute notices to ADHC participants whose days are being reduced.

Three advocacy groups charge ADA, Medicaid violations

The lawsuit was filed by attorneys with Disability Rights California, AARP Foundation Litigation, and the National Senior Citizens Law Center, alleging violations of the Americans with Disabilities Act (ADA) and federal Medicaid law.  "If these cuts are allowed to go into effect, class members who are elderly and have significant disabilities and who could otherwise remain at home or in the community will be forced into nursing homes," says Barbara Jones, attorney with AARP Foundation Litigation.

“Ironically, these cuts will not only cause irreparable harm to the thousands of people and ADHC programs affected by the cuts, but they will also result in increased costs to the State and counties in hospitalization, nursing facility placements, Adult Protective Services, and emergency services,” says Elizabeth Zirker, attorney with Disability Rights California.  Gilda Garcia, a Plaintiff in the case, expressed her fears, “I live alone and even though I can do a lot of things for myself, my diabetes is so unstable that I still end up in the hospital sometimes.  The nurses at ADHC check me every day, five days a week.  On the weekends, I just pray not to have problems.  If I lose ADHC, I know I will end up in the hospital a lot more.”

Plaintiffs argue that the State cannot make across-the-board cuts to people who have been determined to need and authorized to receive them from the Medi-Cal program.  “The State cannot shirk its obligation to provide medically necessary services to each and every Medi-Cal participant.  If the State chooses to reduce ADHC services across-the-board, it still must, according to federal law, provide the skilled nursing and therapy services people receive in the centers to the people who need them” says Anna Rich, attorney with National Senior Citizens Law Center. 

Typical health conditions of ADHC recipients

The 36,000 Californians who participate in ADHC average 78 years old and take six or more medications a day, for which nearly 2/3 require supervision or assistance.  More than 2/3 also face at least three serious medical challenges including cardiovascular disease (39%), dementia (13%), and diabetes (10%).  The overwhelming majority (92%) are entirely dependent on Medi-Cal funding for their care. 

Visit the case homepage for more information.

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