In the business world, it's considered common courtesy to give an employer at least two weeks' notice before quitting a job. And that's about how much notice many of Vermont's elderly, poor and most severely disabled residents received before being told about cuts in the basic services they need to keep them out of hospitals and nursing homes.
In a March 15 letter to 1800 of its clients, the Vermont Department of Aging and Independent Living (DAIL) announced that as of April 1, it was reducing benefits under the Medicaid Home and Community-Based Waiver Program. This allows Vermonters who are severely disabled and require significant personal care to receive in-home assistance as an alternative to being admitted to a nursing home. The program pays for care providers to help them with bathing, dressing, meals, housekeeping, laundry, shopping and other daily activities.
Vermont Legal Aid's Senior Citizen Law Project has filed a class-action lawsuit in Washington Superior Court to stop the cuts from taking effect. According to project staff attorney William Dysart, the financial impact would be devastating to Vermont's most vulnerable citizens, who were never given an opportunity to comment on or voice opposition to the policy change.
"These people are so grateful that they're getting anything. Many of them are frightened to death that they're going to lose these services," says Dysart. "These are people who are literally on the doorstep of a nursing home."
The Senior Citizens Law Project filed the suit March 31 on behalf of 1800 recipients of the program, as well as four specific plaintiffs who are profoundly disabled and unable to care for themselves. Each stands to lose at least several weekly hours of personal care, which could result in some of them having to leave their homes. Currently, the state pays for only part of their daily care.
"This is a great program," says Dysart. "It's been a win-win situation for the state and the beneficiaries because it saves Medicaid long-term care dollars, it allows people to age in [their homes], get services and avoid institutionalization."
Admittedly, the cuts don't take effect all at once. Recipients of the Medicaid Home and Community-Based Waiver Program are evaluated every 12 months from the date they began participating to see how their personal needs have changed. As clients reach their anniversary, the state will reevaluate their needs and scale them back under the new policy.
As of press time, a spokesperson with DAIL could not be reached for comment. The cuts are likely due to federal budget slashes to Medicaid, which could result in a shortfall of about $80 million in Vermont this year.