Court ruling to affect in-home care benefits

The state could spend an additional $18 million to $20 million a year on in-home care for people who are elderly, disabled or infirm, as the result of a Washington Supreme Court opinion handed down Thursday.

The 6-3 decision invalidated part of a computerized tool the state has used since 2003 to standardize the way workers determine certain Medicaid benefits.

The tool essentially allowed state workers to translate a series of questions about daily activities and health into a number. For example, workers asked clients whether they could prepare their own meals. Get dressed without help? Bathe on their own?

Based on their answers, the computerized system came up with the number of hours of in-home care a client qualified for.

But for clients who lived with their caregivers, there was one more step: The system automatically reduced those hours by 15 percent. The state figured that certain household tasks, such as meal preparation and housecleaning, benefited both the caregiver and the client, and therefore the state isn't legally bound to pay.

The so-called shared-living deduction affected about 11,000 clients statewide, according to Bill Moss, the director of Home and Community Services for the state Department of Social and Health Services (DSHS). The state pays in-home caregivers about $10 an hour.

Three of the shared-living clients challenged the 15 percent reduction through the courts, which led to Thursday's ruling. Lawyers for the three argued that under federal law, Medicaid benefits provided to one client cannot be different from those provided to another client who has similar needs. The blanket 15 percent deduction, which was applied only to people in shared-living situations, violated that law.

The Supreme Court agreed. The automatic reduction "does not address, and in fact ignores, the realities of the recipients' individualized situations," said the opinion, written by Justice Charles Johnson.

And those individualized situations can vary widely, according to Meagan MacKenzie, one of the lawyers representing the recipients. For incontinent clients, it might mean washing sheets or clothes several times a day. For clients on special diets, it might mean shopping for and preparing special meals.

The ruling will allow one of her clients, a senior citizen with severe developmental disabilities, to stay out of an institution, she said. Another client can continue receiving care from her son. Moss, of DSHS, said the department is still analyzing the opinion and can't determine yet what effect it might have.

Chief Justice Gerry L. Alexander, and Justices Tom Chambers, Susan Owens, Richard B. Sanders and James M. Johnson joined Charles Johnson in the majority opinion. Dissenting were Justices Mary Fairhurst, Barbara A. Madsen and Bobbe J. Bridge.

Maureen O'Hagan: 206-464-2562 or mohagan@seattletimes.com