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Ball v. Rodgers (Biedess/Betlach)

Settlement in Arizona Ensures Provision of Home Care Services


Final approval of a settlement of a long-running case in which AARP attorneys represented home-based care recipients marks a milestone impacting health care policy across the country, ensuring the recipients will receive the care they were promised.

Ending a lawsuit initiated in 2000, the U.S. District Court for the District of Arizona on Oct. 22, 2012, approved a settlement in Ball v. Betlach. At issue was whether the state had violated Medicaid law and the Americans with Disabilities Act (ADA). Before the case was settled, the litigation featured hard-fought battles over whether Medicaid recipients had the right to sue to enforce benefits in the first place, whether a prior consent order could be modified because of state budget constraints and whether the state had failed to meet a standard of care to which beneficiaries were entitled. AARP Foundation Litigation attorneys along with the Arizona Center for Disability Law represented the plaintiffs.

Medicaid requires that certain institutional long-term health care services be provided to beneficiaries, but allows state Medicaid programs to have programs that allow those services to be provided at home instead of in institutions such as nursing homes. However, if a state opts to have those programs, it must follow through on its promises. The plaintiffs argued that Arizona’s Medicaid program failed to provide promised and necessary home health care to older people and people with disabilities, leaving many people in dangerous conditions. As detailed in the Ball litigation, one 77-year-old woman unable to walk or get out of bed unassisted was stranded in bed for more than 12 hours at a time when attendant care workers failed to arrive as promised. The problem is not limited to older persons. A 3-year-old boy with severe developmental disabilities who was authorized for 740 hours of care per year received none; and on more than 10 occasions a 42-year-old woman with systemic lupus was left stranded in her wheelchair for days at a time.

In 2000, home health care recipients charged the state with violating federal Medicaid law and the federal ADA. Trial on a statewide class action was held in 2003. Ruling strictly on the basis of federal Medicaid law, the court ordered that the state must ensure beneficiaries do not suffer any gap in service, have in place adequate alternative or contingency plans for instances when a service is unable to be provided, and monitor its program so that gaps in service can be detected, contingent plans triggered and any gap be rectified within two hours.

The court also ordered the state to offer a rate of pay to workers to ensure there are sufficient health care workers to serve Medicaid beneficiaries who qualify for assistance. Finally, the court ordered the state to inform each beneficiary of his/her rights, and to implement a grievance process that has a phone number staffed by a live operator so that any gaps in service can be immediately reported and processed, and so that resolutions and contingency plans can be explained to the caller.

Arizona appealed, and the case began working its way up and down the courts, complicated by intervening decisions in other cases that affected the litigation, and disagreements as to whether the underlying order requiring the state to comply must remain in effect. Ultimately, the U.S. Court of Appeals for the 9th Circuit referred the case to mediation, where after lengthy negotiations, the parties reached a settlement now approved by the district court.

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Find cases in which AFL has advocated in courts nationwide for the rights of older persons, and filed AARP’s amicus curiae (“friend of the court”) briefs that help courts decide precedent-setting cases. The cases within the drop-down categories below are in alphabetical order for ease of searching.

Strengthening Law and Policy through
Legal Advocacy

Our legal advocacy initiatives  - conducted by AARP Foundation Litigation (AFL) - reflect nearly 20 years of work in federal and state courts across the country. Through our efforts, we support the Foundation’s four impact areas: Tackling Senior Hunger, Paving the Way to Stable Income, assuring the adequacy and availability of Safe and Afffordable Housing and Reconnecting People to Families and Communities, and ensure that those 50 and older have a voice in the laws and policies that affect their daily lives.