Top court rejects Medicaid eligibility standard

Maryland’s highest court ruled today that Maryland’s health department used a too-strict standard in determining Medicaid eligibility for at-home health services—a victory for Legal Aid and AARP, which argued the case at the Court of Appeals.

“This is great news and  a victory for elderly and disabled people throughout the state of Maryland,” said Legal Aid senior attorney Mary Aquino, one of the attorneys who argued the case.

The decision vindicates the rights of people with dementia, who are low-income eligible and get health related services at home or in assisted living facilities, said Aquino, who represented 86-year-old Ida Brown, whose application was rejected from the Older Adults Waiver Program in 2005.

The decision could affect as many as 13,000 Marylanders who are either in the program or waiting for approval to apply.

“The court’s ruling is good for people like Mrs. Brown and her daughter, who was her caretaker for years,” said Bruce Vignery, a lawyer at the AARP Foundation Litigation, who also argued the case. “It’s great news for family members of people suffering from Alzheimer’s and older people in general.”

Brown suffers from Alzheimer’s, osteoarthritis, osteoporosis, elevated cholesterol levels, hypertension, bilateral cataracts and a benign brain tumor. The state argued Brown did not require constant care from a licensed healthcare professional, its standard for admission to the program.

The Court of Appeals affirmed a decision last November by the Court of Special Appeals, which held that the Maryland Department of Health and Mental Hygiene’s standard was stricter than federal eligibility requirements for the program, which allows people 50 and over to get Medicaid coverage at home or in assisted-living facilities for long-term services that are normally only covered in nursing homes.

“Maryland cannot set a higher bar for eligibility under the Older Adults Waiver Program than is prescribed by the federal government,” Judge Mary Ellen Barbera wrote in the intermediate appeals court’s reported opinion last year.

Joseph DeMattos, director of AARP’s Maryland office, called the decision “a very encouraging sign. A lot of Marylanders have been suffering under these unfair standards.”

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