Court strikes down tighter rules for Medicaid home care program

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A state appeals court has struck down tighter eligibility standards for a Medicaid home care program.

The Fourth District Appellate Court in Madison said the Health Services department should have put the new standards in an administrative rule in which the public could have had their say beforehand.

Instead, the agency simply changed its policy in 2005.

Susan Cholvin of Beloit filed suit after losing her care.

An administrative law judge and a circuit court ruled against her, and the group Disability Rights Wisconsin won an appeal on her behalf.

Group attorney Mitchell Hagopian said he’s not sure how many people were ruled ineligible by the new guidelines, but Thursday’s court ruling could let them reapply.

The program provides nurses to help the elderly and disabled stay at home instead of going to hospitals or nursing facilities.

It served over 27,000 people in 2006.

Under the old rules, a person could get home care if he or she needed help for at least one bad day a month.

The new rule required 10 bad days.

State officials called it a non-binding guideline. But the appeals court said it was a hard and fast rule which caregivers had no discretion to break.

Health agency spokeswoman Stephanie Marquis said the change was never meant to be an administrative rule.

She said people must get the long-term care benefits they need. The agency’s attorneys will look at their options.

Tags: wisconsin, news, medicare, home, care