Lawsuit against Idaho alleges lack of notice about Medicaid cuts

A lawsuit filed Thursday in federal court against the Idaho Department of Health and Welfare says the agency failed to give patients with developmental disabilities proper notice about changes to Medicaid that cause the patients to “face imminent institutionalization.”

The lawsuit asks to block the state’s planned cuts to reimbursement rates for in-home care, which are slated to go into effect Feb. 1.

The cuts were announced in mid-December and prompted an outcry from providers, some of whom said they will no longer offer services because they could not do so without losing money.

Eight providers and two patients sued at the end of December, alleging the department failed to go through the state’s rule-making procedures — including a public comment period — before deciding to cut rates.

The state plans to lower daily payments for “intense” care from $497 to $268 per patient. The state also plans to reduce payments for other services. The department has said it will monitor what happens after reimbursements change to ensure patients are getting adequate care.

“Because [the Idaho Department of Health and Welfare and its leadership] have chosen to pretend that services will not be reduced, they have not provided plaintiffs with notice of the service reductions that are an inevitable result of cutting reimbursement rates, and have not notified plaintiffs of their right [or] an avenue to appeal, all in violation of the right to due process,” the lawsuit filed Thursday said.

The lawsuit also alleges violations of the Americans with Disabilities Act.

The lawsuit claims that hundreds “and likely thousands” of people may be affected.

The lawsuit, filed by Boise attorney James M. Piotrowski, did not provide full names of plaintiffs. It identified the plaintiffs using initials, describing them as adults with developmental disabilities who receive residential habilitation services via Medicaid.

The plaintiffs are people with multiple disorders who qualify for “intense” care because, among other things, they have a history of violence, criminal or sexual offenses, aggression or severe medical conditions that require one-on-one care:

▪  Plaintiff S.D. in Boise “suffers from moderate cognitive impairment, mood disorder, seizure disorder and Lennox Gastuat type epilepsy,” receiving around-the-clock one-on-one care “solely because his parents serve as his direct care providers,” the lawsuit says.

▪  Plaintiff J.H. in Southwest Idaho has “bipolar disorder, mild cognitive impairment, anxiety disorder, seizure disorder, type II diabetes and a number of other medical conditions.” She receives “intense” level care to make sure she follows doctor’s orders and stays safe. She has fought with roommates to the degree that police got involved and she was charged with a misdemeanor, the lawsuit says.

▪  Plaintiff Z.Y. somewhere in Idaho has autism, attention deficit/hyperactivity disorder and type I diabetes and tried unsuccessfully to live independently. He receives “intense” care in part to make sure he treats his diabetes and keeps his home clean and livable, the lawsuit says.

▪  Plaintiff J.O. also somewhere in Idaho has Asperger Syndrome, Reactive Attachment Disorder and ADHD. “He also exhibits traits of bi-polar disorder,” the lawsuit says. He has lived in shared housing and assaulted roommates with a knife, tried to kick a police officer and has been arrested at least twice and tried to harm himself in jail, it says.

This story was originally published January 14, 2016 at 6:25 PM with the headline "Lawsuit against Idaho alleges lack of notice about Medicaid cuts."