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Oster v. Wagner

AARP Asks Federal Appeals Court to Overturn California Law Cutting Back Community Based Services

California's In-Home Supportive Services (IHSS) program provides a range of in-home assistance services to low-income older people, without which many people would face unwanted institutionalization or hospitalization. IHSS allows older people to age in place in the communities and housing they call home, at costs far reduced from what the State would pay if they were institutionalized or hospitalized.

Last year, however, the California legislature passed a bill known as ABX4 — over the strong opposition of AARP California — that reduced access to Medicaid-funded IHSS services. Recipients sued to overturn the law, and a federal district court issued an injunction preventing the law from taking effect. The state appealed.

Plaintiffs in Oster v. Wagner, which is before the U.S. Court of Appeals for the Ninth Circuit, argue that ABX4 conflicts with federal Medicaid law and should be permanently overturned.

AARP's Brief

Attorneys with AARP Foundation Litigation filed AARP's brief in support of the plaintiffs, pointing out that cuts in IHSS not only violate federal law, but are bad public policy. Numerous studies show that older people do better in less restrictive settings. The brief notes that there is a clear policy trend toward giving individuals the option to receive long-term care services in their communities, and that aging at home reduces Medicaid spending in the long term. For example, the brief takes note of a 2003 study that found that compared with an average daily nursing home cost of $118 per person, the average daily cost per IHSS recipient was $24 per day and even the most expensive IHSS recipients cost less than $100 per day.

AARP's brief also points to numerous studies showing that a majority of older people want to remain at home as they age, and that community engagement helps older people live longer and happier lives. Finally, the brief argues that under the U.S. Constitution's Supremacy Clause, states cannot pass laws that conflict with federal statues or regulations — and that ABX4 does precisely that by conflicting with federal Medicaid law. Moreover, the brief argues, the recipients have the standing to challenge violations of Medicaid law, as reinforced by recent decisions of the 9th Circuit.

What's at Stake

The clear trend in long-term care across the nation is for older people and persons with disabilities to be integrated into their community and to choose the living situation they want, that meets their needs, with the support they need. ABX4 would directly counter that trend, and fly in the face of scholarship, experience and personal choice, while increasing government spending unnecessarily, thereby restricting services to the smallest number of people.

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