Be Alert for ADA Violations in Medicaid Cuts

by Steve Gold on January 1, 2009 - 2:52pm

QUEST Vol. 16, No. 1

Advocates should be aware that if your state reduces its Medicaid home-care services, whether personal attendant care hours and eligibility, home health, number of prescriptions, or other services, there may be ADA (Americans with Disabilities Act) legal challenges available to stop these reductions.

Be on the lookout in your state for:

  1. Medicaid reductions that discriminate based on severity of disability so that reduced benefits will provide adequate services for people with less severe impairments, but not be adequate for people with more severe disabilities.
  2. Community-based Medicaid reductions without any significant reductions in the institutional expenditures. Think about how many Medicaid funds could be “saved” in your state by reducing the nursing home Medicaid per-diem reimbursements by $3 a day.  With 53.3 percent of the 1,153,601 nursing home residents paid by Medicaid, a $3-per-day reduction could go a long way to resolving other budgetary reductions.
  3. Medicaid reductions that force people, in order to survive, to have to go into an institution to receive the same services that they had been receiving in the community. People with disabilities of any age should not have to go into a nursing home in order to receive services!
  4. Medicaid reductions that are not individually determined and therefore do not provide for flexibly applying “reasonable accommodations” to assess what services may be necessary to stay out of an institution.
  5. Medicaid waiver reductions that are based on “individual” cost neutrality rather than “aggregate” cost neutrality.
  6. Reductions and payments for services that do not recognize and take different levels of “need” into account, but instead lump all disabled persons into one need-category.

I have no doubt that, if your state officials think the disability and elderly advocates will take reductions in community-based services lying down, they will use the current economic climate as an excuse.

Power concedes nothing without a struggle. 

Steve Gold, a disability advocate and attorney based in Philadelphia, publishes information bulletins on a variety of disability-related topics. His Web site,, has a searchable archive of bulletins. Contact Gold at or call (215) 627-7100.

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