Category

In-Home Supportive Services

California Plaintiffs Win Case Against State for Failing to Provide Federally-Mandated In-Home Supportive Services

By | CA Health Network Alert, In-Home Supportive Services, PRESS RELEASE

State must reimburse or pay Medi-Cal recipients and conduct statewide outreach to thousands of Californians who may be eligible for in-home services

LOS ANGELES — Thousands of Medi-Cal beneficiaries with significant disabilities will now be able to access affordable Medi-Cal care at home, rather than going to a nursing facility. In-home care provides greater stability and health outcomes for individuals and families, and it is cost-effective for the state; but it can be prohibitively costly to pay for out-of-pocket. As a result, married people with disabilities often have to make a draconian choice: impoverish themselves and their spouses or go to a nursing facility.

“My wife and I live primarily on a fixed income of pensions and social security; we exhausted our life savings and retirement accounts paying for my care,” said plaintiff Patrick Kelley, a 68-year-old U.S. Army veteran living with spastic quadriparesis. “My wife’s ability to work was severely limited by her caregiving responsibilities to me. We spent almost all of her limited income paying for my in-home care.”

Thanks to the successful lawsuit against the state, married people with disabilities will now learn about their right to Medi-Cal eligibility so they can stay at home with their spouse, receive care, and be reimbursed through the state’s Medi-Cal program for In-Home Supportive Services (IHSS). The court ruling makes it clear that the state must fully implement a federal law, known as the expanded spousal impoverishment protection, which should have been implemented as part of the Affordable Care Act in 2014.

“This ruling will dramatically improve the quality of life for disabled Californians and their family caregivers and will prevent many Californians from falling into poverty due to the high cost of in-home care,” said Kim Selfon, IHSS Client Advocate at Bet Tzedek. “Caregivers selflessly care for their disabled spouses with courage and compassion, often to the detriment of their own finances and health. They and thousands of others will now have the support they need to continue caring for their loved ones at home.”

The two plaintiffs’ situations illustrate the diversity of the thousands of individuals that will be impacted by the outcome of this case.

“The judge’s decision is a boost to Welfare and Institutions Code section 10500, which says agencies must secure for every person the aid to which they are entitled. As California’s population ages, in-home care will become increasingly important to the future of the state,” said attorney Cori Racela of Western Center on Law & Poverty.

Plaintiff Matthew Reed is a 63-year-old man with multiple sclerosis, Bell’s Palsy, and vascular dementia from a stroke. Due to the severity of his disabilities and medical condition, Mr. Reed is eligible for Medi-Cal home services, and should have had access to care without out-of-pocket costs under spousal impoverishment protections. Instead, he was required to pay more than $1,500 per month for care, which he cannot afford.

“If the spousal impoverishment rule had been implemented as it should have, Matthew could have been found eligible for free Medi-Cal and IHSS,” said Matthew Reed’s wife, Vicki Reed. “That means my son or I could have earned IHSS wages, sparing us incalculable stress and anxiety and giving us better options for Matthew’s home care and more financial resources. I don’t want any other families to go through what we have gone through.”

The Affordable Care Act set a deadline to expand spousal impoverishment protections to home-based care starting January 1, 2014. However, the Department of Health Care Services (DHCS) failed to issue any guidance about the rule until July 2017, after Mr. Kelley and Mr. Reed brought this lawsuit.

The ruling in Patrick Kelley & Matthew Reed v. California Department of Health Care Services, et. al., was issued by a Los Angeles Superior Court judge on January 14, 2020. It concludes that DHCS must a) notify beneficiaries who could benefit from the rule, particularly those denied or discontinued from Medi-Cal because DHCS failed to implement the rule on time; b) create a process for people to be found eligible for IHSS retroactively to the date they applied for Medi-Cal; and c) allow impacted individuals to be paid for home services they were entitled to during the delay period.

“Choosing between remaining at home without needed services, impoverishing oneself and one’s spouse, or moving into a facility separate from loved ones is no choice at all,” said Claire Ramsey, Senior Staff Attorney at Justice in Aging. “This ruling means relief for many who have struggled to stay at home and in their community and receive the services they need.”

Bet Tzedek is committed to providing free legal services to those that need them most. Bet Tzedek attorneys and advocates help people of all communities and generations secure life’s necessities. Wherever people are in crisis, Bet Tzedek’s core services and rapid response programs provide stability and hope. Founded in 1974, Bet Tzedek – Los Angeles’ House of Justice – helps over 50,000 people each year.

Justice in Aging is a national organization that uses the power of law to fight senior poverty by securing access to affordable health care, economic security, and the courts for older adults with limited resources. Since 1972 we’ve focused our efforts primarily on fighting for people who have been marginalized and excluded from justice, such as women, people of color, LGBTQ individuals and people with limited English proficiency.

Disability Rights California (DRC) is the agency designated under federal law to protect and advocate for the rights of Californians with disabilities. The mission of DRC is to advance the rights, dignity, equal opportunities, and choices for all people with disabilities.

Western Center on Law & Poverty fights for justice and system-wide change to secure housing, health care, racial justice and a strong safety net for low-income Californians. Western Center attains real-world, policy solutions for clients through litigation, legislative and policy advocacy, and technical assistance and legal support for the state’s legal aid programs. Western Center is California’s oldest and largest legal services support center.

# # #

Contact: Vanessa Barrington
510-256-1200 direct
vbarrington@justiceinaging.org

Advocates Guide: In-Home Supportive Services (IHSS)

By | Advocate's Guide, CA Health Network Alert, In-Home Supportive Services, REPORTS

The In-Home Supportive Services (IHSS) program is a Medi-Cal program in California that pays for in-home care for people with disabilities, including children, adults, and seniors. The purpose of this vital program is to provide services and supports that help people remain safely in their homes and living in the community.

Justice in Aging is releasing a new Advocates Guide about the IHSS program for advocates and individuals who provide assistance to older adults, children, and adults with disabilities. Written with significant support from Disability Rights California, the guide provides in-depth information about the IHSS program and is divided into eight chapters:

  • IHSS Program Overview;
  • Eligibility and Applying for IHSS;
  • Medi-Cal Programs and IHSS;
  • IHSS Services Overview;
  • Types of Services;
  • IHSS Providers;
  • Post-Eligibility Issues;
  • and Appeals and Hearings.

Dementia Patients Wait Months For Long-Term Care In Vermont Hospitals

By | Alzheimer's & Dementia, Health Care, IN THE NEWS, In-Home Supportive Services

Vermont Public Radio: Dementia Patients Wait Months For Long-Term Care In Vermont Hospitals (April 24, 2019)

Many seniors in Vermont who suffer from dementia are waiting months, and some up to a year, in hospitals before being accepted into nursing homes. Seniors affected by long wait times also tend to qualify for Medicaid and have health conditions that call for higher staffing needs. Justice in Aging’s Directing Attorney Eric Carlson said that the state’s nursing home waits are “atypical.” And that “the level of difficulty that you’re talking about in Vermont is far above what I think the average is.” Advocates recommend increasing Medicaid’s nursing home reimbursement rate and creating specialized dementia facilities.

More older residents on Medicaid wait list in Florida than any other state, attorney says

By | Health Care, Home & Community Based Services, IN THE NEWS, In-Home Supportive Services, LITIGATION, Long Term Care, Medicaid

Florida Record: More older residents on Medicaid wait list in Florida than any other state, attorney says (January 7, 2019)

A lawsuit has been filed against the state of Florida over extremely long wait time in accessing in-home Medicaid care. Justice in Aging, along with Disability Rights Florida and the Southern Legal Counsel, is representing the six plaintiffs currently suing the state.

“According to national statistics, there are more older adults and adults with disabilities on the wait list for community-based services in Florida than any other state,” Regan Bailey, litigation director for Justice in Aging. “The failure to provide long-term care places people at risk of unnecessarily entering a nursing facility just to get the care they need which should be provided at home.” Read the full article.

Florida Faces ADA Lawsuit Over Medicaid Wait List

By | Health Care, IN THE NEWS, In-Home Supportive Services, LITIGATION, Long Term Care, Medicaid, Person-Centered Care Planning, SENIOR POVERTY

WJCT News/WUSF Health: Florida Faces ADA Lawsuit Over Medicaid Wait List (January 2, 2019)

Justice in Aging has filed a class action lawsuit against Florida’s Agency for Health Care Administration. Currently, older adults and people with disabilities could wait up to 3.5 years to access in-home health care. Justice in Aging wants Florida to develop more in-home care services for people and increase the capacity of the services it has. Litigation Director Regan Bailey said “it’s a need that’s growing. And the way to meet that need is to provide more community-based services because you can serve many more people for the same money in the community versus in a nursing facility.”

Thousands of backlogged cases in Bay Area home care programs

By | Health Care, IN THE NEWS, In-Home Supportive Services

Fox KTVU: Thousands of backlogged cases in Bay Area home care programs (10/11/2017) The Bay Area has thousands of backlogged In-Home Supportive Services (IHSS) cases preventing seniors in need of additional in home support. IHSS allows qualified elderly and disabled individuals to hire services in order to remain safely at home. For those in need of additional hours, a social worker must physically visit and assess the claimant’s situation. According to Justice in Aging’s Claire Ramsey, “Every day and month that goes by, that person is living unsafely in their home. People do hurt themselves or fall because they’re not getting help they need…it’s a dangerous situation.”

Fact Sheets: IHSS Services and Eligibility & Application Process

By | FACT SHEET, In-Home Supportive Services, REPORTS
The IHSS program serves more than 500,000 Californians and ensures they receive the care and support they need to live in the community. The program is structured to provide a high level of flexibility and autonomy to the recipients. This consumer-driven approach has a lot of positives, but has introduced complexity into the program.

Two new fact sheets explain two facets of the In-Home Supportive Services (IHSS) program—Eligibility and the Application Process, and IHSS Services: Basics. These fact sheets provide a simplified starting place to understand how the eligibility and application process work, what services are available, and how the county determines eligibility for specific services.
Read More

California Lawsuit Aims To Protect Spouses Of Disabled From Financial Ruin

By | CA Health Network Alert, IN THE NEWS, In-Home Supportive Services, Long Term Care, Medicaid, Nursing Homes

California Healthline: California Lawsuit Aims To Protect Spouses Of Disabled From Financial Ruin (7/10/2017) Justice in Aging, along with partner advocacy groups, filed a lawsuit against the State of California for failing to implement a Medicaid federal spousal impoverishment law meant to protect patients and their partners from becoming impoverished while paying for in-home care. Plaintiffs seek to compel the State of California to implement the law back to January 1, 2014, to notify individuals who potentially were eligible for the protections of their rights, and to reimburse them for any out-of-pocket expenses they paid that should have been free.

New Regulations Create Opportunity for Better Long Term Services and Supports: Medicaid Managed Care Regulation Preview

By | BLOG, Health Care, Home & Community Based Services, HOMEPAGE, In-Home Supportive Services, Person-Centered Care Planning
States and the federal government spend over $14 billion a year on Medicaid managed long-term services and supports—yet, there has never been an clear federal regulation defining state and managed care plan responsibilities in this massive enterprise. Until now. Last week, the federal Centers for Medicare & Medicaid Services (CMS) released a final regulation on Medicaid Managed Care. This new regulation details, among other things, the federal government’s expectations for states and managed care organizations (MCOs) that contract to deliver managed long-term services and supports (LTSS) for older adults and people with disabilities. Read More

Hanging in the Balance: a day in the life of a low-income senior and her family caregiver

By | Alzheimer's & Dementia, BLOG, Health Care, HOMEPAGE, In-Home Supportive Services, Medicaid, Medicare, SENIOR POVERTY
In honor of November as National Caregivers Month, I want to tell you about Margaret and Sadie. I went to Old Bridge Township, New Jersey last month to meet with them and hear stories of what it’s like to be a daughter caring for your low-income mother as she ages in her home and what it’s like to be that mother and grandmother and great-grandmother aging in dignity. You can watch the full video about Margaret and Sadie here. Read More