Disabled testify about care-hour cuts during Medicaid hearing.

Hearing required so state can reapply Medicaid algorithm

Although it was 19 years ago that a car accident left her paralyzed from the chest down, it was only recently that Andrea Reaves developed her first pressure sores from long hours of sitting in a wheelchair.

At a public hearing Thursday, she blamed a reduction two years ago in the amount of help she receives with daily living tasks, such as moving from the wheelchair to her bed.

“My question is, why must I and thousands of other disabled Arkansans live in constant fear of being placed in an institution?” said Reaves, 35. “Why are our hours [of home-based care] being cut significantly, when our conditions aren’t improving?”

Reaves of Benton was among several people who spoke at the hearing in Little Rock about an algorithm that the state began using in 2016 to award hours of homebased care to people on the ARChoices Medicaid program.

Ruling in a lawsuit by Jonesboro-based Legal Aid of Arkansas, Pulaski County Circuit Judge Wendell Griffen on May 14 found that the state Department of Human Services failed to give adequate public notice when it adopted rules authorizing the use of the algorithm.

He barred the state from using the algorithm until the rules had been “properly promulgated” under the Administrative Procedure Act.

The hearing on Thursday — part of the promulgation process spelled out in the law — allowed members of the public to comment on proposed rules that would allow the state to start using the algorithm again.

Similar hearings were held earlier this month in Jonesboro, Fort Smith, Monticello and Hope.

According to Legal Aid, the use of the algorithm has resulted in widespread cuts to people in the ARChoices program, which provides homebased services to Medicaid recipients with disabilities severe enough to qualify for placement in a nursing home.

The tool assigns recipients to “resource utilization groups” based on their medical diagnoses and answers to questions about their needs.

Most recipients are limited to fewer than 40 hours a week of care, with more hours available to those who meet special criteria, such as relying on machines that help with breathing or being fed through intravenous tubes.

Previously, when Human Services Department nurses had discretion in awarding hours, recipients could receive up to 48 hours a week under a program serving the elderly and 56 hours under one that served younger recipients, according to Legal Aid.

Both programs were combined into ARChoices in 2016.

Before her hours were cut, Reaves, who has a 4-year-old daughter, said the Medicaid program paid for one caregiver to visit her eight hours a day, five days a week, and another, her brother, for about eight hours a week.

Now, it pays for seven hours of care, five days a week, from her main caregiver and about five hours a week from her brother.

“With nurse discretion this would not have happened,” Reaves said. “The nurses would have been able to see my situation and know that a decrease in hours would cause more harm to my health and limit my ability to be a mother and live in my home and be able to have a job and contribute to my community.”

Robert Moore, 36, of Bull Shoals, who suffered a brain injury about 24 years ago that left him with little ability to move or speak, watched from his wheelchair as his father read his statement. The younger Moore’s hours were reduced earlier this year from about 56 hours a week to 37.

In the statement, he said the process for allocating hours should start with one question: “Can you in any way take care of any of your basic daily needs to sustain life?”

“If the answer is no, the questions should end and that person should get the maximum number of hours,” he said in the statement.

With Griffen’s order in place, the department said it has been unable to enroll new participants in ARChoices or reassess the needs of those already in the program.

As of June 25, the department had a backlog of 1,116 applications that had not been processed and 1,377 program participants who were overdue for annual reassessments.

Legal Aid filed a second lawsuit earlier this month in attempt to force the department to resume the assessments and reassessments while giving nurses discretion in awarding hours.

The department will accept written comments on the rules allowing the algorithm through Tuesday.

Mark White, deputy director of the Human Services Department’s Aging, Adult and Behavioral Health Services Division, said the rules will likely go the Legislative Council for final approval in September and, if approved, take effect Oct. 1.

The department also plans to propose rules that would allow it to switch to a different formula for awarding hours. Those rules would likely go into effect a few months after the first set of rules, White said.