A recent administrative law case showed that the Department of Social and Health Services cannot adopt rules that have the effect of imposing "one size fits all" measurements on people who require Medicaid assistance due to developmental disabilities. In this case the Department had determined that a fifteen year old girl with severe developmental disabilities was eligible for twenty-four hour a day institutional care for managing the tasks of daily living. The girl lived with her mother who was her care giver and was enrolled in a program that allowed her to receive benefits for living at home rather than being institutionalized. This was reflected in a determination by the Department that the girl should receive Medicaid Personal Care in the amount of ninety hours per month. Then in 2005 the Department adopted a rule that presumed that a portion of a child's care was for development, not due to medical need, and that a portion of the child's care that was provided by a parent living with the child would substitute for the otherwise required Medicaid Personal Care. These presumptions could not be challenged by medical evidence. In fact the girl had a physician's report that said she needed ninety six hours of Medicaid Personal Care per month but there was no place to present that evidence. The Supreme Court decided that the Department's rule presumptions violated federal law that requires comparability of Medicaid benefits among similarly situated people. The court invalidated the Department's "one size fits all" rule and upheld an award of over $85,000 in attorneys' fees to the girl.
The preceding is for instruction and should not be considered as legal advice. Please see my website on administrative law at http://www.seattle-realestate-lawyer.com/aspx/m/Administrative-Law
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