Kerr v Kentucky Department for Medicaid Services
Kentucky Residents Deemed Ineligible for Medicare Win Chance for Reevaluation
The parties have reached a tentative settlement apparently valued at more than $13 million in a class-action filed against the Kentucky Department for Medicaid Services and the Kentucky State Cabinet for Health Services on behalf of thousands of Kentucky residents who lost their eligibility for nursing home or in-home care because of stricter rules that were enacted in April 2003. Persons eligible to take part in the reinstatement of care should contact the attorneys for the class for more information.
The settlement is a significant victory for elderly and disabled Kentucky residents who either lost their eligibility or were deemed ineligible upon application because of the new rules. The plaintiffs' lead attorney, Anne Marie Regan, stated, "We basically got everything that we wanted." In a press release, Dr. James Holsinger, secretary of the Cabinet, said the state agreed to the terms because it wants to provide care to those who need it.
The settlement guarantees that the state will revise eligibility criteria for nursing home or in-home care to resemble rules that were in place before April 2003, when then-Governor Paul Patton tightened the regulations to save money. Many people will now have to meet only two of 12 criteria to retain their benefits. Criteria include needing help with a wheelchair, having to be fed, and requiring assistance to use the toilet. For cases that do not pass muster, the cabinet will complete a second review using updated information about patients' conditions. For those people who still do not qualify, an appeals process will be available for review of their applications.
The settlement also addresses people who were denied services based only on a diagnosis of mental illness, mental retardation, or a related condition. The state admitted that it ultimately wants to set up a special program to provide coverage to those individuals, but in the meantime, their benefits will be reinstated as long as they meet the other eligibility criteria.
The settlement stipulates that the cabinet must provide monthly reports on the status of each case to the plaintiffs' attorneys. In addition, the cabinet agreed not to substantially change the rules for nursing home or in-home care again for at least a year. The court will retain jurisdiction over the case for at least two years to ensure periodic review of the reinstatements.
The settlement will not be effective until the court grants it final approval. The court has scheduled a hearing on the matter for August 10, 2004.
