Hawaii DOH appeal decision opens the door for restoration of Medicaid waiver cuts

BY SUMMER HARRISON, ON NOVEMBER 15TH, 2009
In December of 2008, Hawaii’s Developmental Disability Division of the Department of Health sent a letter out to participants in the state’s DD waiver program,
announcing an across the board cut of 15% in home and community based services.
The written decision issued by the Department of Health in a Kauai child’s appeal of these cuts may have opened the door for this set of cuts to be restored
immediately.
In referring to the parent’s deferral to “case management” to arrange alternative funding for her daughter’s services while the services themselves remained
unchanged, the hearings officer “agreed with [the parent] that case management is charged with assisting families to obtain such services and similarly
situationed families can defer to case management for assistance.”
While this writer isn’t a lawyer, the concept of “similarly situated families” can be defined in its broadest sense to include all the families of individuals who had
their DDMR waiver home and community services cut in 2009.
The hearing office concluded that the child’s service hours should remain unchanged while DDD case management arranged for alternative funding.
According to the state of Hawaii’s agreement with the federal Medicaid regulatory agency, Evercare and Ohana (the two for-profit companies providing
Medicaid EPSDT and home and community services to the disability and elderly communities) were to continue to provide the same services as had been
provided previously under all of Hawaii’s Section 1915(c) waiver programs.
Any “changes related to eligibility, enrollment, benefits, enrollee rights, delivery systems, cost sharing … evaluation design, sources of non-Federal share of
funding, budget neutrality and other comparable program elements” must be requested in writing from CMS 120 days in advance.
A constantly changing Level of Care scoring tool, and across the board cuts to home nursing services, para transportation and adult dental care (among other
areas) would seem to qualify under that definition for requiring advance notice. To date, no evidence the state requested such advance approval has been
provid
The question arises therefore if Hawaii, in order to bring itself back in compliance with its own contract with the feds, needs to reinstate all Medicaid home and
community services cut since July 2008 while case managers arrange for alternative funding from Evercare and Ohana.