Magazine article Developments in Mental Health Law
ADA Expands Range of Individuals That May Be Entitled to Medicaid Funded Home and Community Based Health Care
The Ninth Circuit joins many other courts that have grappled with the scope of the Americans with Disabilities Act (ADA) and its impact on Medicaid waiver programs. The state of Washington participates in the federal Medicaid program that provides federal financial assistance to states that choose to reimburse certain costs of medical treatment for needy persons. Participation by states in this program generally is optional but a state receiving Medicaid funds must comply with the requirements of the Medicaid Act. An exception to this rule is the Medicaid waiver program under which certain Medicaid requirements can be waived for innovative or experimental state health care programs. The programs encouraged by the waiver program include increased provision of home and community based health care to Medicaid recipients who would otherwise only qualify for nursing home care.
The Medicaid Act groups needy persons into two categories, usually distinguished by income level: the "categorically needy" and the "medically needy." A participating state must provide certain types of services to categorically needy persons. In Washington, persons whose income is below 300% of the Social Security Income Federal Benefit Rate are deemed categorically needy. For medically needy persons, the state is only obligated to establish "reasonable standards" for determining the extent of assistance it will offer. Washington provides through the Medicaid program long-term medical care and living assistance in nursing home settings to both the categorically and the medically needy. …