From Disability Rights North Carolina, shared Dec. 8:

U.S. District Court Judge Terrence Boyle today stopped the State of North Carolina from implementing policy on Medicaid personal care services that he said treats people with similar needs differently and puts North Carolinians “who have been successfully living in their own homes. . . at risk of segregation, in the form of institutionalization.”

The Americans with Disabilities Act (ADA) prohibits the unnecessary segregation and unjustified institutional isolation of persons with disabilities. The State is required to provide federally-funded services “in the most integrated setting appropriate to the needs of the individual,” and the Medicaid Act requires that recipients not be treated differently when they have similar levels of need.

In his order granting a preliminary injunction and class certification, Judge Boyle found that plaintiffs offered sufficient evidence that the State’s policy on personal care services violates the Medicaid Act’s requirement to provide comparable services and the ADA’s integration mandate.

The policy under review allowed individuals in facilities such as Adult Care Homes to be eligible for personal care services by meeting one set of eligibility requirements and required individuals in the community to meet a far higher standard of need. Under the policy, individuals who would not be eligible for personal care services while living in the community would get the care they needed by entering an Adult Care Home.

Judge Boyle also ruled the plaintiffs were likely to be successful on the claim that the letters sent to the plaintiffs to deny them services failed to comply with due process because the letters “contained verbatim language that failed to provide detailed reasons for the proposed termination” and that this was unlikely to be sufficient for a service that “could be quantified as a brutal need.’”

The Due Process Clause of the Constitution requires adequate notice be provided when a Medicaid service is terminated. In granting the preliminary injunction and motion for class certification, Judge Boyle recognized that the “(l)ack of in-home PCS could result in either serious physical or mental injury or forced entry into institutional settings for many of the named Plaintiffs and members of the class…”

“We are thrilled with Judge Boyle’s decision. He confirmed our position that the State’s policy pushed people toward institutional settings,” says Vicki Smith, Executive Director of Disability Rights NC. It is our hope that this decision will encourage the State to develop policies that articulate a clear priority to keep people in their homes and community. Such policies will be cheaper and lawful — a double win for the N.C. taxpayers.”

Plaintiffs are represented by Disability Rights NC, Legal Services of Southern Piedmont, and the National Health Law Program.

Click here to read Judge Boyle’s order in Pashby — 12/8/11.

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Kathleen O'Nan is a contributing reporter to Carolina Public Press.

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