WA Supreme Court ends “arbitrary” restrictions

The graphic is the outline of the shape of Washington a portion of the state flag inside it.

The Washington State Supreme Court struck down two state regulations that allowed the state Department of Social and Health Services to make automatic reductions to Medicaid-funded personal care services, for children with disabilities who live with their parents.

“We wanted to make a systemic impact for children in Washington State,” said Andrea Kadlec, mother of Samantha A., the lead plaintiff in the case. “When families have the right supports, they can avoid costly and painful decisions, like whether or not to place children in institutions.”

In 2005, DSHS changed the rules governing its formula for determining the number of hours of Medicaid Personal Care children may receive. Many children receive personal care through the state’s Home and Community Based Waiver, which is designed to ensure people with disabilities are able to live in their homes, as opposed to institutional settings. MPC is also available under the State Medicaid Plan. The 2005 changes required DSHS to automatically reduce MPC hours for any child under the age of 18 living with a legally responsible parent.

Samantha A. was one of the 3000 children affected by the rule change. Prior to the formula change, Samantha received 90 hours of personal care services each month. After the rule was changed, she continued to need these services, but the rule automatically reduced her hours from 90 to 39.

When her mother appealed the change, the Administrative Law Judge said that DSHS followed its own rules, which required the 57 percent reduction to automatically occur, despite evidence that the reduction would leave her with insufficient service hours.

Represented by Disability Rights Washington, Samantha petitioned for DSHS’s rules to be invalidated because they violated federal Medicaid law. In June of 2009, Samantha won at superior court, which determined that the rules were invalid because DSHS did not take into account individualized evidence about her needs, including the recommendation of Samantha’s pediatrician for 96 hours of monthly care in order to “maximize her potential and achieve her best possible functional level.” DSHS appealed the decision, which was heard before the Washington State Supreme Court in November 2010.

With its decision, a 5-4 ruling, the Washington State Supreme Court has now invalidated the rule changes. “In short, DSHS’s age- and parent-based reductions represent arbitrary amounts applied without any supporting evidence and without regard to an individual recipient’s actual needs,” wrote Associate Chief Justice Charles Johnson for the majority.

Samantha’s mother said she was relieved the outcome would restore support for so many Washington families. “I would want people to look at this case and see that with the right support, Samantha is an engaging, capable young lady,” Kadlec said. “She’s a joy to be around. When the supports disappear for people with disabilities, that’s when things unravel.”

DisAbility Rights Washington is part of the federally funded protection and advocacy system and a member of the National Disability Rights Network.