More elderly and disabled patients in North Central Florida and across the state are expected to be able to stay in their homes following a recent lawsuit led by a Gainesville lawyer.
The suit — filed in part by Medicaid and special-education attorney Nancy Wright in 2015 against the Florida Agency for Health Care Administration — was settled in December 2016.
The settlement made in U.S. District Court says that Medicaid patients who might have been moved to a facility outside the home will receive extra accommodations in their homes.
The settlement is meant to ensure that a disabled person on Medicaid living at home, for example, should expect to receive the amount of care deemed necessary, such as a ventilator, an around-the-clock nurse or whatever she or he might need.
But because of a lack of guidelines for long-term care (or continual care that's often needed for the elderly, disabled and chronically ill), those expectations weren't being met, Wright said, noting that was the primary reason behind the lawsuit.
The suit began in 2015 after Rita Parrales, a nurse in Miami-Dade County, quit her job, scarcely left home and was getting as little as two hours of sleep a night to care for her adult daughter, Adriana.
Adriana has a rare genetic disease that has left her bed-ridden, attached to a ventilator and in need of continual care.
When Parrales requested assistance from her insurer – Florida’s Medicaid program – she said she was denied the resources she needed to care for her daughter. It was then that she contacted Wright because of Wright's expertise in Medicaid issues.
After being made aware of Parrales' case, Wright said she found many similar instances of Medicaid enrollees in need of long-term care being denied basic assistance. This stemmed from Medicaid case managers not having enough guidance when assessing a patient’s needs for living comfortably at home, she said.
“It was very obvious that there was no standard for Medicaid to hang their hats on that shows managed-care organizations what elements are required to give a certain level of service to patients,” Wright told WUFT News.
Kirsten Anderson — an attorney at Southern Legal Counsel, which filed the suit with Wright — said the settlement “will lead to a wide variety of policy changes to make sure people are getting appropriately assessed, and service organizations are receiving clear criteria to better care for patients.”
As a part of the settlement, a handbook will be written by the Florida Agency for Health Care Administration explaining that the same quality of at-home care is given to all patients, Wright said.
Anderson said such care "promotes peoples' dignity and well-being."
"If someone is able to live safely, forcing them into an institution is discrimination," she said. "They have a right to be in the most integrated setting possible."
Nursing care and other at-home services are paid for by Medicaid by a federal government waiver program.
Florida has several similar waivers, which allow the state to save money by avoiding putting individuals in institutions. (Institutions are, on average, more expensive than at-home care, Wright and Anderson said.)
“From the state’s perspective, it really costs less money to keep people in the community and out of assisted-living institutions," Anderson said. "And it’s better for certain patients, as well.”
But Wright said she fears enrollees will continue to overlook the quality of care they are entitled to.
She said the process for providing care needs to be uniform and easy and that she still believes there needs to be further action to provide proper long-term care to Medicaid patients.
“It would be like giving someone a list of ingredients but not telling them what to make of it," she said, noting that Medicaid case managers do already have lists of care that should be given but aren't properly following through on providing that care.
Correction: An earlier version of this article incorrectly called the settlement a "ruling." Also, the last quote in the story has been updated to provide proper context.