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Some to regain benefits in WV’s Medicaid waiver program

CHARLESTON, W.Va. — Five disabled West Virginians who are suing the state Department of Health and Human Resources over cuts to its Intellectual/Developmental Disabilities waiver program should get the same amount of funding they got in 2014, before the cuts were put in place, a federal judge has ruled.

U.S. District Judge Thomas Johnston issued a preliminary injunction that orders the DHHR to reinstate the plaintiffs’ individualized budgets to the amounts they received in 2014.

The judge did not rule on whether to certify the case as a class action, as attorneys had asked in the lawsuit; such a move would allow people similarly affected to join the lawsuit.

The lawsuit, filed by attorneys for the nonprofit law firm Mountain State Justice, argues that the way the DHHR has run its I/DD waiver program violates the Americans with Disabilities Act. They filed a request for injunctive relief against the DHHR last year, on behalf of five waiver recipients, to make the agency reverse course on cuts to the program that went into effect this year.

“We’re very pleased with the court order,” said Lydia Milnes, an attorney for Mountain State Justice. “We think it shows a good understanding of the issues and challenges facing our clients. We’re looking forward to a further ruling on our motion for class certification.”

The I/DD waiver program provides severely disabled West Virginia Medicaid recipients money for in-home services and community-based programs. The program provides services to 4,534 West Virginians. Another 1,100 are an a waiting list for the program, according to the order.

The state Bureau for Medical Services, which administers the Medicaid program, contracts with APS Healthcare Inc. to conduct an “annual assessment of each program participant’s abilities and needs,” according to the order. Each person’s budget from APS is determined by a “secret and proprietary computer algorithm.”

Before fall 2014, APS made independent decisions on granting funds exceeding a participant’s budget, and routinely granted them, the order states.

That changed in September 2014, when Bureau of Medical Services employees saw that the program was exceeding its budget and instructed APS to stop unilaterally approving program plans that exceed the budgets, the order states.

“These denials resulted in substantial decreases from 2014 to 2015 in the total benefits Plaintiffs received through the I/DD waiver program, even though Plaintiffs’ need for services did not diminish during this time period,” the judge wrote. “This lower funding correspondingly results in a reduction of services Plaintiffs can purchase.”

In a statement, Jeremiah Samples, deputy secretary for the DHHR, said the department will comply with the order.

“The DHHR has already implemented many of the changes outlined in the court’s order, and it will continue exploring strategies to make further appropriate modifications,” Samples said. “The DHHR remains committed to providing services to vulnerable populations, including expanding services to the more than 1,000 West Virginians on the program waiting list, within the allocated budgets provided by the Legislature during these difficult fiscal times.”

Reach Lori Kersey at [email protected], 304-348-1240 or follow @LoriKerseyWV on Twitter.

To see more from the Charleston Gazette-Mail, click here. 

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