A U.S. District Court judge issued an injunction Tuesday to halt deep cuts to Medicaid and restore about $16 million in assistance to Idaho's developmentally delayed adults.
The decision lets an American Civil Liberties Union of Idaho lawsuit on behalf of disabled Idahoans proceed as a class-action case, opening it up to about 3,600 people who lost some their Medicaid dollars when the program was slashed in 2011.
That's not every adult with mental disabilities in Idaho, but it's a sizeable slice of them, ACLU of Idaho Legal Director Richard Eppink said. Those who are institutionalized - living permanently in a nursing home or state hospital - won't be subject to the injunction. The suit isn't seeking monetary damages.
"We're suing just to fix this system and fix it as soon as possible," Eppink said. "If we can make those changes, then we'll be very happy."
Idaho Department of Health and Welfare spokesman Tom Shanahan declined to comment on the case's newest development. He said department heads had not yet reviewed the ruling or discussed it with their legal team.
The ACLU launched the lawsuit it in 2012 on behalf of 13 severely disabled Idahoans, who were unable to afford the same levels of therapy and other care after their benefits were cut. The state typically assigns developmentally delayed adults an "individual budget" for the year, which caps how much each client can spend on medical needs. But the cuts in recent years left clients with less money and fewer opportunities to thrive, Eppink said.
Judge B. Lynn Winmill agreed, citing in his decision the case of an Idaho man with Down syndrome who needs help feeding and dressing himself. The man, identified only as K.S. in court documents, was able to meet people and improve his social skills through a community program. But a 25 percent cut to his Medicaid budget in 2011 threw his chance to continue the program into jeopardy.
Without an opportunity for such services, K.S. and other plaintiffs have a higher chance of being institutionalized and "risk stagnating or more likely regressing in their functional levels because of the reduced levels of support they can afford with their diminished budgets," Winmill wrote.
The judge's decision also orders the Idaho Department of Health and Welfare to disclose why someone's benefits have gone down, giving them a chance to dispute the reduction. But that's been a challenge for the state health department, Eppink said.
"The problem the department faces is that in many cases, they don't even know themselves," he said. "They can't even explain why somebody's number goes down under this very complex formula they've tried to use."
In an earlier phase of the suit, courts ruled the department had to disclose how it was calculating those numbers something officials were calling a "trade secret." After the ruling, the department revealed it used a spreadsheet that plugs in numbers based on types of disability and levels of assistance needed to perform daily tasks. That's something Eppink says the ACLU's lawsuit will likely tackle next.
"The next phase of this case is probably going to be about whether that formula, that system that they use, is even fair and appropriate," he said.
It's not yet clear when those 3,600 people will begin receiving increased funding. Although the order is supposed to take effect immediately, but it may take days for the department to set up procedures to change individual budgets.
The increased payouts should be automatic, he said, but advised disabled Idahoans or their caregivers to look back over the past few years to see what funding and services they needed before getting in touch with a caseworker or other employee at the state health department.