A hearing officer has reversed a decision by the state Department of Human Services to take a 79-year-old Parkin man off a Medicaid program that helps people with daily living tasks.
In an order dated June 13, hearing officer Otis Hogan said the department failed to show during a May 13 hearing that Bennie King no longer needs extensive assistance with "transferring" activities, such as moving from his bed to a wheelchair.
"Based on testimony and evidence in the record, Mr. King continually requires extensive assistance with transfers and bed mobility as evident in the record file and through sworn testimony of parties," Hogan wrote.
King, who suffers from end-stage renal disease and heart disease, is among about 10,000 low-income Arkansans who receive home-based services under a Medicaid-funded program that is meant to provide an alternative to nursing-home care.
In March 2015, Human Services Department nurse JoAnne Hendrix found that King qualified for the services because he required the assistance.
During a reassessment less than a year later, in January 2016, the same nurse found that King no longer needed such assistance.
Both the March 2015 and January 2016 assessments were conducted using a tool known as the ArPath, which involves asking more than 200 questions about a person's medical condition and physical limitations.
In his order, Hogan cited testimony by Hendrix that King, who is illiterate and hard of hearing, may have scored differently in March 2015 and January 2016 because relatives had helped him answer questions during the earlier assessment.
Hogan also cited Hendrix's testimony that the results of the assessment could vary depending on a person's condition on a particular day.
For instance, Hendrix said it's possible that King would be found to have greater needs on a day when he had been weakened by a dialysis treatment.
Hogan also noted that Hendrix initially thought King would qualify for continued assistance and awarded him 94 hours per month of attendant care services, an increase from the 52 hours per month that he had previously received.
"Mr. King testified that he is able to do far less than he was able to last year in regards to transfers and locomotion, and that he now gets out of his chair far less," Hogan wrote.
Kevin De Liban, a Legal Aid of Arkansas attorney who represented King in the appeal, said the decision is "a great affirmation of Mr. King's need for the services and for the idea that DHS needs to prove why somebody who's been previously allowed the services is no longer eligible when their medical condition hasn't improved at all."
De Liban said the department should take steps to ensure the ArPath is administered more consistently.
In a lawsuit filed in federal court last month on behalf of two other Medicaid recipients, De Liban said the use of the ArPath has resulted in "the widespread denial and termination" of services for Arkansans who were later found eligible for Medicaid-funded nursing-home care.
The department has used the ArPath since 2013, according to the suit.
The suit challenges ArPath assessments that resulted in a reduction in the hours of attendant care services provided to Bradley Ledgerwood, a 34-year-old Cash man who has cerebral palsy, and Ethel Jacobs, a 90-year-old Helena-West Helena woman who has Alzheimer's disease.
According to the suit, the medical conditions of Ledgerwood and Jacobs hadn't improved, and their responses to questions during the ArPath assessment appeared to indicate that their needs were the same or greater than when they were assessed in previous years.
In a court filing, Lori Rose, nurse manager for the department's Aging and Adult Services Division, said the ArPath is based on an assessment tool "developed by researchers from over 30 countries committed to improving care for the disabled or medically complex."
Of the 2,643 ArPath reassessments performed from Jan. 1 through May 1, 53 percent resulted in no change or increases in attendant care services hours, and the rest resulted in reductions, Rose said in the filing.
U.S. District Judge D. Price Marshall Jr. last week put proceedings in the case on hold until administrative appeals by Ledgerwood and Jacobs are resolved.
Metro on 06/22/2016