A decision to slash funding for Medicaid has real and tangible effects on people’s lives, such as those of Lillie Brantley, Allie Jo Woodward and Gilda Garcia. Lillie Brantley is 84 years old and severely impaired by Alzheimer’s disease and dementia. Allie Jo Woodward, 79 years old, has bipolar affective disorder, depression and a host of physical ailments including diabetes, glaucoma and hypertension. Gilda Garcia is 77 years old and has had unstable diabetes since 1995. Ms. Brantley, Ms. Woodward and Ms. Garcia all receive services benefits from Medi-Cal Adult Day Health Care (ADHC), a community-based program for low-income seniors and younger adults with disabilities in the state of California. ADHC provides an organized day care program that includes therapeutic, social and skilled nursing health activities enabling participants to restore or maintain their capacity for self care. These crucial services, including daily professional nursing services to monitor their health; daily personal care services to assist with day-to-day living tasks; social services to improve their mental and emotional well-being; and physical and occupational therapy to increase their physical strength and functionality, have enabled Ms. Brantley, Ms. Woodward and Ms. Garcia to live independently with the assistance of family members, who provide part-time care when not working. Ms. Brantley, Ms. Woodward and Ms. Garcia cannot afford private care and their family members cannot afford to quit their jobs to provide full-time care (nor are they qualified to provide all of the care needed). As a result, cuts to the ADHC program will deprive these women (and many others) of the care and company they depend on, and most certainly place them at risk of hospitalization and/or institutionalization.
Despite the fact that programs like ADHC and other Medicaid services are notoriously underfunded, the California state legislature passed a law cutting ‘Medi-Cal’ payments (Medicaid reimbursements) to medical providers by ten percent in 2008. The state legislature voted for an additional five percent payment reduction in early 2009. In making these cuts the state failed to take into account the effect that they would have on the already scarce services to low-income people living in medically underserved areas and for people with disabilities. The state also disregarded federal law requiring them to consider, among other things, whether payment rates are consistent with the ability of health care providers to offer quality care and sufficient to recruit enough providers to ensure that care and services are available. As a result of these cuts, low-income enrollees across the state have suddenly found themselves unable to fill and pay for their prescriptions, and hospitals and other care facilities have been unable to provide adequate treatment to their Medicaid patients as required by law.
Recently the U.S. Supreme Court agreed to weigh in on a trio of lawsuits regarding California’s cuts. The three cases, known collectively as Maxwell-Jolly v. Independent Living Center of Southern California, California Pharmacists Assn, and Santa Rosa Memorial Hospital, were filed on behalf of Brantley, Woodward and Garcia (and others like them) and yet again raise the issue of access to the courts for individuals and groups to enforce laws meant to protect their rights. In all three ‘Maxwell-Jolly’ cases, the federal district and appeals courts ruled that, despite the budget climate, California could not cut Medicaid spending so drastically without taking into account federal requirements that the program ensure affordable, quality health care for low-income individuals and families, and for people with disabilities. At the Supreme Court level, the issue up for consideration is whether or not the federal Medicaid law meant to safeguard access to healthcare for those in need can take priority over the California state law cutting the Medicaid budget. The Court will also decide whether Brantley, Woodward, Garcia and others who are affected by the cuts have the right to go to court to enforce federal Medicaid rules. This case is yet another example of a court case involving below-the-radar-screen procedural issues that have real-life, serious and potentially life-threatening ramifications for thousands of people across the country. We can only hope that, when making its decision, the Court chooses to keep Ms. Brantley, Ms. Woodward and Ms. Garcia in mind.
(Photo by LOLren.)