Missouri court says home health law discriminates

Tuesday, January 13, 2009 | 9:42 p.m. CST; updated 9:47 p.m. CST, Tuesday, January 13, 2009

JEFFERSON CITY — A state home health care law discriminates against some people with mental disabilities by denying them coverage, the Missouri Supreme Court ruled on Tuesday.

The decision invalidates a 2005 change in state law that prohibited participation in a personal care program by people who have a legal limit on their ability to make decisions, such as through the appointment of a guardian.

Barbara Bechtel, of Valley Park, had been paid through the state program to provide personal care for her adult daughter, Andrea Bechtel, who has physical and mental disabilities requiring the use of a wheelchair and help with daily activities.

But the Bechtels were dropped from the personal care program as a result of the 2005 law, which also eliminated or reduced Medicaid health care benefits for thousands of low-income adults.

In a unanimous decision written by Judge Richard Teitelman, the Supreme Court said the 2005 personal attendant law discriminates against people with disabilities by providing help to people with physical limitations but excluding those who have guardians because of mental limitations.

The court cited the federal Americans with Disabilities Act, which prohibits public entities from denying benefits or program participation to people because of their disabilities.

After the Bechtels were booted from Missouri's personal attendant program, Andrea Bechtel was enrolled for a while in a Medicaid program that provides in-home care. But that program prohibits family members from providing the paid care and covers only medically related services, not necessarily including housekeeping and daily living aid.

Andrea Bechtel subsequently also lost eligibility for the Medicaid program because of her income levels, said Anthony Rothert, legal director for the American Civil Liberties Union of Eastern Missouri, which represented her in the court case.

Since then, her mother has continued to care for her, but the time commitment has prohibited her from holding another job, Rothert said.

"Really some of the neediest and most vulnerable people were kicked off the program and deprived of the services they needed," Rothert said. "That's why I'm glad the federal anti-discrimination laws are there, so the more vulnerable don't get left out because of cost-cutting."

Rothert said he knows of other individuals who also have been excluded from the program because they have guardians. But it was unclear Tuesday how many people could be affected by the court ruling.

A spokeswoman for the Missouri Department of Social Services, which administers the program, said officials were reviewing the court ruling and had no immediate comment.

The American Federation of State, County and Municipal Employees, a union which represents home health care workers, issued a statement saying the court ruling highlights that "there must be greater access to Missouri's home care program and that too many unjust restrictions exist today."


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Charles Dudley Jr January 13, 2009 | 11:39 p.m.

On this note if the entire system was privatized and allowed to work of it's own devises some of the conditions might be even worse than they are now.

Thank God for Government control in some form to ensure accountability for the disenfranchised and this at risk population.

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