If you are a senior citizen or a person with disabilities under Florida's Medicaid Managed Care program, there is good news if you want to receive that care at home.
Florida's Agency for Health Care Administration (AHCA) is creating new rules that raise the standard of home-care services under its Long-Term Care Waiver Program, allowing seniors and those with disabilities to be among their loved ones and avoid skilled nursing facilities.
A recent lawsuit settlement requires Florida's Medicaid Long-Term Managed Care companies "to provide an array of home and community-based services that enable enrollees to live in the community and to avoid institutionalization."
For example, Adriana Parrales, a young woman with a rare genetic disorder, is now free from constant worry that she would end up in a facility. The lawsuit settlement affects more than 45,000 Floridians like her, who will now have significantly more protections in place to ensure that their care needs are adequately met at home. Parrales and four other citizens sued AHCA in August 2015, contending that the system placed them at risk of being institutionalized because it was not providing adequate standards or over-sight for home care.
Under the settlement, AHCA has also agreed to changes in their contract with managed care, trainings and consumer education, and better program monitoring.
When managed care took over the program, Parrales experienced wildly varying assessments of her needs and suffered a reduction of more than half of her services. After a hospitalization that left her on a ventilator, she was discharged home without either private duty nursing or respiratory therapy, leaving her mother to provide around-the-clock skilled care.
Josephine Hollister, another plaintiff, requested a transfer from a nursing facility to her own home, but was denied the coverage prescribed for her discharge. Determined to live in her own home, she exhausted her own small income and had to rely on voluntary help from her guardian to get the services she needed.
The plaintiffs contended that the managed-care organizations ignored critical issues such as need for supervision, caregiver availability, and access to community services.
My law firm filed the lawsuit along with Disability Rights Florida and Southern Legal Counsel. The Long-Term Care Waiver Program is supposed to substitute for nursing-home care, allowing people to remain in their own homes or in less restrictive community settings. When care needs are not met, caregivers are pushed to the extreme, and enrollees are not safe or just end up going into nursing homes, like it or not.
"The Americans with Disabilities Act prohibits discrimination based on disability, which includes being forced into unnecessarily restrictive settings to receive care," said Amanda E. Heystek, Esq., Disability Rights Florida. "Ms. Hollister wanted to live at home, and just needed the right amount of care in order to safely do so."
Disability Rights Florida is the state's designated protection and advocacy system for persons with disabilities, and Southern Legal Counsel is a statewide nonprofit public interest law firm funded by The Florida Bar Foundation.
Other organizations, such as the Academy of Florida Elder Law Attorneys, are also keeping a watchful eye on the Medicaid Managed Care program, monitoring the quality of care for senior citizens and those with disabilities.
The impact of the lawsuit is already being felt. Parrales' managed care company is now providing her with nursing care and appropriate therapies. Hollister, who died recently, was able to get the services she needed to stay in her home with her beloved dog by her side.
Nancy Wright is a sole practitioner in Gainesville, Fla. focusing on Medicaid home- and community-based services for adults and children with disabilities and the elderly. Nancy has been a member of the Florida Bar since 1980 after graduating with high honors from Florida State University College of Law.