A federal district court in Illinois denied the state Medicaid agency’s motion for summary judgment in a case testing whether a man with severe disabilities can receive care at home under the state’s Medicaid waiver program rather than in a nursing home. Grooms v. Marah (N.D.Ill., No 06 C 2211, May 30, 2008).

David Grooms, a severely disabled young adult who requires a ventilator to breathe, lived at home with almost constant care provided under the Medically Fragile Technology Dependent Children’s waiver program. When he turned 21 and he aged out of the program, Mr. Grooms sought in-home care through the adult Persons with Disabilities waiver. Under this program, the state provided Mr. Grooms only with limited in-home care, equal to the level he would receive if he were living in a skilled nursing facility. He can receive a hospital-level of care, which he required due to his severe disability, only in an institution.

Mr. Grooms filed suit against the Illinois Department of Healthcare and Family Services under the Americans with Disabilities Act (ADA) and the Rehabilitation Act, alleging that he was being forced into an institution because the state refused to pay for his necessary in-home care under the waiver program. Mr. Grooms argued that, under the ADA mandate, the state should provide him with the same level of in-home care it would be required to provide if he were hospitalized. The state moved for summary judgment, countering that compelling an increase in Mr. Grooms’ care rate was not reasonable in light of substantial increase in the cost of care required if the state were to comply with Mr. Grooms’ request.

The U.S. District Court for the Northern District of Illinois denied the state’s motion for summary judgment and scheduled a hearing to determine what kind of relief Mr. Grooms deserved. The court found that “as evidenced by his participation in the MFTDC program, until Grooms turned twenty-one, the State recently determined that it was cost-neutral for him to receive home care.” The court also decided that the state has not presented enough evidence proving that altering Mr. Grooms’ care rate would “fundamentally alter” the state’s waiver program.

The full text of this decision is available at: www.elderlawanswers.com/