[Hpn] Mediciad & ADA

Thomas Cagle nh-adapt@juno.com
Tue, 28 Jan 2003 07:03:56 -0500


From: Steve Gold <SteveGoldADA@CS.COM>


MA cutbacks and the ADA - # 46

    Weekly we read about States threatening to cut back on Medicaid. Some
reductions may have no direct disability impact, but others might. The
disability community must be particularly attentive to the need for grass
roots organizing and to how the ADA could be used to trump potential cut
backs.

    According to the Kaiser Commission, in 2003 we will see many States
attempt to reduce their budgetary deficits by reducing Medicaid
expenditures.
 Our task is to ensure "equal opportunity" so that the specific and
different
Medicaid needs of disabled persons are taken into account, to remember
that
the Supreme Court in Alexander v. Choate recognized that people with
disabilities were entitled to "meaningful access" of Medicaid services as
a
"reasonable accommodation," and at the same time to separate cutbacks
that
are not primarily "disability" related.

    Here are some suggestions to keep in mind regarding disability
handles:

    1.    Prescription Drugs: Even if nondisabled persons' prescriptions
are
capped, the ADA's "reasonable accommodation" should provide for
"meaningful
access" for individual disabled persons who require more prescriptions
than
the cap. While prior authorization for prescriptions, reduced payments to
pharmacists and increasing co-payments for prescriptions may not directly
connect to disability, nevertheless a cap on the number of monthly
prescriptions or prohibiting specific medications does directly affect
people
with disabilities.

    2.    Restricting Eligibility Criteria for Medicaid benefits:   The
primary way this will directly impact on persons with disabilities is
when
States set higher financial eligibility for institutional care than they
set
for community-based care or waiver services, thereby ensuring unnecessary
institutionalization in violation of Olmstead.  That is, if disabled
persons
are financially eligible for institutional Medicaid nursing home
services,
but the same person is not financially eligible for Medicaid
community-based
services, that triggers Olmstead.  Again, focus on specific individuals.

    3.    Reduction of Benefits and Services: Caps on the number of Home
and
Community-Based waiver slots directly affects the disabled and should be
challenged under Olmstead, as does increasing the reimbursements for
nursing
homes without a comparable increase for the community.  Similarly,
reducing
or eliminating occupational and physical therapy, DME, power wheelchairs
directly impacts on rehabilitation of disabled persons, particularly if
those
services are provided in the institution but the State refuses to provide
them in the community.

    4.   Requiring Co-Payments and Reducing Provider Payments: Unless
these
are imposed primarily on "disability" benefits, they probably will be
permissible.

WHAT ADVOCATES SHOULD DO:

    1.    To fight these and other Medicaid cutbacks requires you have a
coordinated response in YOUR state?   Because these reductions will
impact on
the disabled community throughout the State, they require a State-wide
organizing and will require lots of coordinated community efforts.
    2.   Use the press to tell your story.  Let the specific persons with
disabilities who will be negatively impacted tell their stories.

    3.   Get to sympathetic State legislators to enlist their assistance.
Make sure the individuals who will be impacted tell the elected
officials.

    Don't mourn; organize.

Steve Gold, The Disability Odyssey continues

Back issues of other Information Bulletins are available online at
http://www.stevegoldada.com
with a searchable Archive at this site.



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