OMAHA, Neb. (AP) - The Nebraska Department of Health and Human Services was wrong to end Medicaid benefits that had helped a woman care for her profoundly disabled daughter at home for more than a decade, the Nebraska Supreme Court ruled Friday, in a case that could affect how the department determines the eligibility of other children with long-term care needs.
The girl, listed only as Brayden O. in the ruling, was born with a rare genetic disorder that causes severe mental disability and skeletal and muscular abnormalities. She must have round-the-clock supervision and must have help to bath, dress, groom, go to the bathroom, eat and communicate. Brayden’s mother, listed only as Merie B., is a registered nurse who is able to provide many of the services Brayden needs at home, but relied for 12 years on the Medicaid-administered Home and Community-Based Waivers program to help provide care for Brayden at home so she could work.
But in November, 2012, the department ended the benefits that provided such services as nursing and respite care for Brayden, even though the girl’s physical limitations had not substantially changed. The department reasoned that the girl no longer met the state’s qualifications that would have allowed her to receive care in a nursing facility - a requirement to qualify for the Home and Community-Based Waivers program.
As the name implies, the program waives income limits to qualify for Medicaid payments used for home help and day care assistance for those who need long-term care services. Parents like the program, because their disabled children can remain at home instead of going to an institution.
The department determined that because Brayden can walk, get in and out of a chair, bed or car and can see and hear, she no longer qualified for the program. Her mother appealed to a lower court, which sided with the department, and then to the state Supreme Court.
On Friday, the Nebraska Supreme Court reversed the lower court’s ruling that sided with the department, saying the department failed to follow its own rules in determining Brayden’s eligibility.
The high court also criticized an exhibit admitted as evidence by the department regarding state rules on qualifying for the program, saying it was created arbitrarily and cherry-picked certain disqualifying factors while omitting categories that would have qualified Brayden for the program.
“(The exhibit) made it more difficult for disabled children than disabled adults to meet eligibility requirements for waiver services. The obvious result was to severely restrict the number of children who qualified for waiver services,” Justice John Wright wrote.
The high court ordered the department to reinstate Brayden’s waiver benefits.
“We received the decision today and are reviewing the order to determine its impact to the department,” department spokeswoman Kathie Osterman said.
Ben Kramer, a Fort Collins, Colorado, attorney who represented Brayden and her mother and argued the appeal before the high court, said he believes the ruling sets a precedent that will require the Nebraska Department of Health and Human Services to re-evaluate the way it determines waiver program eligibility for disabled children.
Kramer said the mother deserves credit for pursuing the case for 2 ½ years.
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