In Special Needs

A U.S. appeals court rules that a significant reduction in private duty nursing hours for a woman with multiple severe disabilities does not amount to discrimination under federal law. Carpenter-Barker v. Ohio Department of Medicaid (6th Cir, No. 17-4301, Aug. 31, 2018).

Megan Carpenter has many serious medical conditions that render her unable to care for herself. Ms. Carpenter, who lives with her mother, receives different forms of government assistance to help with the constant care she needs. For many years, as ordered by her treating physician, the Ohio Department of Medicaid (ODM) authorized 168 hours a week of private duty nursing (PDN) for her. In 2009, ODM prevailed in reducing her PDN to 128 hours a week.

In 2013, ODM further reduced the number of weekly PDN hours to 56, arguing that Ms. Carpenter received assorted services that were duplicative and that private care aides could do much of the work performed by nurses. A subsequent settlement allowed Ms. Carpenter to continue receiving 128 hours a week of PDN. Just two months after the settlement, ODM again reduced the PDN hours to 56 a week, based on its evaluation of medical necessity. Pending her administrative appeal of that reduction, Ms. Carpenter’s mother, Cynthia Carpenter-Barker, filed a federal lawsuit alleging that ODM had violated the “integration mandate” that was the basis of the U.S. Supreme Court’s decision in Olmstead v. L.C., 527 U.S. 581 (1999).  Ms. Carpenter-Barker claimed that the reduction in PDN care put her daughter at risk of institutionalization. The district court granted summary judgment in favor of ODM but stayed it from reducing Ms. Carpenter’s PDN pending her appeal.

The United States Court of Appeals, Sixth Circuit, affirms the lower court’s decision. The court explains that Olmstead did not “set a standard of care or specifically require that states offer all the aid a patient wants.” States may rely on reasonable medical assessments and judgments of its public health officials in determining what assistance an individual requires. ODM’s decisions with respect to Ms. Carpenter were based on individualized determinations by its medical professionals and did not rise to the level of discrimination prohibited by law.

To see the court’s full opinion, click here.

To see our earlier coverage of the district court’s ruling, click here.

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