Arizona state flag

A court order has been issued in one of the country’s most long-running and high-visibility Medicaid class action law suits affecting home and community-based services.

In Ball v. Betlach, a U.S. District Court Judge ruled on March 8 that Arizona’s Medicaid program failed to follow the court’s prior orders by not implementing a statewide hotline for beneficiaries to report gaps in critical home care services and by failing to require its program contractors to have backup workers on call to substitute for times when a gap in critical services occurs.

PHI Director of Policy Research Dr. Dorie Seavey provided expert testimony in the case.

Failure to Provide Adequate Home and Community-Based Care

The original class action lawsuit was filed in 2000 by attorneys from the Arizona Center for Disability Law and the AARP Foundation Litigation on behalf of Arizona Medicaid beneficiaries who are elderly or living with disabilities.

The plaintiffs alleged that the Arizona Health Care Cost Containment System (AHCCCS) was not providing these consumers with adequate home and community-based services (HCBS), such as attendant care, personal care, and homemaker services, which make it possible to live in the community rather than be forced into more institutional nursing homes.

After a trial in 2004, Judge Earl H. Carroll found that the state’s failure to provide home care workers caused the plaintiffs to be “trapped in bed unable to change position or care for personal hygiene, abandoned for hours in a bathroom, left without food or water.”

The court ruled that, by declining to provide all of the home care services authorized, Arizona “failed to provide the representative class members with the equal access, quality of care, and freedom of choice to which they are entitled” under the federal Medicaid statute. Carroll ordered Arizona to provide all critical home care services and to fill all gaps in services within two hours.

Expert Testimony from PHI’s Seavey

Seavey, who testified at the original trial, prepared an expert report (pdf) for the court’s most recent ruling that investigates the adequacy of the steps that AHCCCS has taken to address the problem of gaps in critical services.

“What’s notable about the Arizona case is that the judicial system has stepped up to insist on basic standards and program requirements for creating reliable backup mechanisms for authorized personal care services, and it also demanded accountability through system-wide tracking and monitoring,” Seavey said.

Without reliable backup, people with disabilities are put at risk when these Medicaid services are not delivered for whatever reason, as a national report coauthored by Seavey explains.

“The evidence I examined,” Seavey says, “suggests that two of the court’s prior orders were not being met: namely, to create a hotline for consumers to call if they experience a service gap, and a requirement that program contractors maintain pools of on-call backup workers. The courts new order seeks to rectify this situation.

“I also found serious deficiencies in the state’s monthly reporting on gaps in critical services and these remain, in my opinion, a serious problem requiring further attention,” Seavey continued. “Without better monitoring, it will be impossible to determine whether the root problem underlying this lawsuit — gaps in critical services — is getting better or, in fact, worse.”

Aspects of the Ball case are currently under appeal to the U.S. Court of Appeals for the Ninth Circuit.

– by PHI Policy Team