An eligibility assessment tool in use since 2013 has resulted in arbitrary reductions and terminations of home-based Medicaid services for the elderly and disabled, a federal lawsuit contends.
The lawsuit against the Arkansas Department of Human Services was filed late Monday by Jonesboro-based Legal Aid of Arkansas on behalf of Bradley Ledgerwood, 34, of Cash, who has cerebral palsy, and Ethel Jacobs, 90, of Helena-West Helena, who has Alzheimer's disease.
The services have helped keep people like Ledgerwood and Jacobs out of nursing homes, where they would end up costing the Medicaid program much more than it has been paying to provide them with services at their own homes, Legal Aid attorney Kevin De Liban said.
"Why the state would threaten that, and why do that in such an arbitrary way that defies all sense of accountability is just a mystery," he said.
Both patients were told in February that their reimbursement for home-based services would be reduced because of assessments using the tool, known as ArPath, according to the lawsuit.
Ledgerwood and Jacobs are among about 11,000 Arkansans with severe disabilities whose eligibility for help with daily living tasks is determined annually using ArPath, De Liban said.
The use of ArPath has "resulted in the widespread denial and termination" of services for people who were later determined eligible for Medicaid-funded nursing home care, the lawsuit says.
Ledgerwood and Jacobs have filed administrative appeals, but contesting the results of the ArPath assessment is difficult because the Human Services Department hasn't provided any information about how the tool works, De Liban said.
The suit contends that the service cuts violate Medicaid recipients' rights under federal Medicaid laws and the U.S. Constitution.
Human Services Department spokesman Kimberly Rusley said the department had no comment on the lawsuit. She said department officials would not respond to a reporter's questions about the assessment tool.
The tool uses a person's responses to about 200 questions to assign the person a score, which determines the person's eligibility for services. The state began using it on Jan. 1, 2013, according to the lawsuit.
Previously, Human Services Department nurses had assessed applicants using a different form and their own "professional judgment" to determine eligibility and the services provided, the lawsuit says.
Applicants assessed using ArPath aren't told what their score is or how it was calculated, the lawsuit says. Information on the formula used to calculate scores is not part of Human Services Department policy, the suit says.
As a result of an ArPath assessment, Ledgerwood was told in February that his eligibility for home-based services would be cut from 56 hours per week to 32 hours per week, according to the lawsuit.
Jacobs' hours were cut from 45 hours per week to 35 per week.
Both Arkansans require almost constant care, including help with tasks such as dressing, bathing and eating, the suit says.
Reducing Ledgerwood's hours of care would make it more likely that his mother would have to seek work and hire someone else to help care for him, according to the suit. Currently she is reimbursed for 40 hours of care per week, and Ledgerwood's father, who works at a tool factory, is paid for 16 hours of care per week.
The program pays the parents $9.74 per hour, De Liban said.
Jacobs' son, Louis Welch, who has power of attorney for his mother and is a former sheriff's deputy, said in the suit that he works 29 hours a week as a security guard at a casino in Tunica and uses the Medicaid program to pay workers to care for his mother while he's at work.
If her hours are reduced, he said, he would have to consider putting her in a nursing home.
The service cuts have been put on hold while the administrative appeals are pending.
The lawsuit asks U.S. District Judge D. Price Marshall Jr. to bar the department from cutting services provided to Ledgerwood, Jacobs or other Arkansans until a different system for determining eligibility is put in place and approved by the judge.
The department hadn't filed a response late Tuesday.
Metro on 05/04/2016