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The Law: Should Medicaid Beneficiaries With Disabilities be Forced to Live in Nursing Homes?

Plaintiffs argue that Florida violates federal law by forcing some adults with disabilities to stay in nursing homes.

John Boyd, a quadriplegic from Jacksonville, Fla., savors his freedom. He gets around on a motorized scooter and this year expects to complete a degree in computer programming at a community college.

But Florida Medicaid rules have forced Boyd, 50, to live in a nursing home.

“Nursing homes are jails without the bars,” says Boyd. “People make decisions for me and about me without my best interests in mind. I should make my own decisions.”

He wants out, and so do roughly 8,500 other Floridians who would prefer to live either in their own homes or in a community setting, according to a federal lawsuit AARP filed in January. Boyd and five other plaintiffs argue that Florida violates federal law by forcing some adults with disabilities to stay in nursing homes.

Medicaid allows nursing home residents only $35 a month in spending money, so they can’t afford transportation, phones or food purchases, the suit says. Sometimes they face curfews. This “perpetuates the segregation of persons with disabilities,” the lawsuit argues.

Nursing home care in Florida is also expensive for taxpayers—roughly $65,000 a year per person versus an average of $39,000 a year for assisted living or community-based care, according to Bruce Vignery, senior AARP Foundation attorney and one of the lawyers on the case.

While Vermont, Oregon, Washington and several other states have moved many disabled and older Medicaid recipients from nursing homes, Florida has not, Vignery says. In 2006, 87 percent of Florida’s Medicaid long-term care funding went to nursing facilities, while only 13 percent went to community-based services; the national average is closer to a 70-30 split.

“Florida has placed a restriction on your ability to live where you want and do what you want,” Vignery says. “That’s wrong. People should have a meaningful choice.”

The U.S. Supreme Court ruled that the Americans With Disabilities Act requires public entities to administer programs in the most integrated setting appropriate, which for many people means living in the place they have long called home, in the communities in which they have become enmeshed.

Meanwhile, Florida’s attorney general wants the case dismissed. State lawyers argue that Boyd wants “this Court to second-guess the manner in which Florida’s elected officials and policymakers have chosen to make medically necessary services available in light of the State’s available resources.”

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