- Associated Press - Sunday, August 24, 2014

ALBUQUERQUE, N.M. (AP) - Family members of developmentally disabled New Mexicans suing the state say a Medicaid-assessment system puts recipients of services at risk, the Albuquerque Journal reported (https://bit.ly/1tHFeCz ) Sunday.

Attorneys for eight families asked a judge Wednesday to halt a new method for evaluating recipients to determine their level of services, which can include 24-hour residential care as well as occupational and speech therapy.

More than 4,100 adults are enrolled in the state’s developmentally disabled waiver program, known as the DD waiver. Under the program, Medicaid waives the requirement that an enrollee must be in an institution to be eligible for the funding.

The lawsuit was filed in January to restore the services lost by some individuals in the waiver program and stop Gov. Susana Martinez’s administration from continuing with changes meant to control costs.

However, the governor’s office disputes that claim and said the changes such as the evaluation system, which is called the Supports Intensity Scale, were to help people off waiting lists for services.

Officials say the waiver program has a waiting list of 6,200. State Department of Health spokesman Kenny Vigil said Sunday that 850 people were taken off the waiting list between 2012 and this year. According to the department, that is an improvement compared with 278 people in the prior three-year period.

“The Department of Health is serving more developmentally disabled New Mexicans now than at any other time in our state’s history,” Vigil said in an email to The Associated Press.

According to the department, a developmentally disabled client cost an average of more than $74,000 in fiscal year 2009. But for this fiscal year, the cost has been just over $70,000. Furthermore, the agency said the evaluation system doesn’t put those clients at risk.

In the lawsuit, the plaintiffs state that 700 recipients have challenged the accuracy of their assessments and categories of care they were assigned. The new evaluation system uses “vague, subjective and arbitrary criteria and procedures,” the lawsuit said, and violates the due-process rights of recipients.

Once a recipient is assigned care based on his or her evaluation score, “they are tied to a limited base budget and menu of available services without regard to individual medical need,” the lawsuit said.

The judge will issue a ruling at a later date.


Information from: Albuquerque Journal, https://www.abqjournal.com

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