Long-promised help for badly disabled still not delivered

Help for severely disabled Nevadans, promised more than a year ago by the Guinn administration, still hasn't materialized, and complaints are escalating into threatened court action.

Just before lawmakers adjourned their last regular session in May 1999, they approved an administration plan to spend $1 million in state and federal Medicaid funds to help the severely disabled avoid being institutionalized. The program was to have helped 30 severely disabled people this fiscal year and another 30 in the coming fiscal year.

The current fiscal year ends in three weeks, about 180 people are still on a waiting list for the benefits, and none of the money has been spent.

The delayed program would expand an existing one in which about 165 Nevadans benefit from a waiver that allows them to earn from $500 to $1,500 a month without losing Medicaid benefits. The waiver allows them to avoid being placed in institutions or other highly restrictive living arrangements.

''The excuses are getting old,'' says Bev Klinghesse of the Northern Nevada Center for Independent Living. ''People are still in nursing homes who should not be.''

''We've got people who are 35, 40 years old sitting in nursing homes who need maybe a couple of hours a day of personal care assistance and they could be out, living fairly independent lives. It's unconscionable.''

Jack Mayes of the Nevada Disability Advocacy and Law Center says a lawsuit could be filed if delays continue in the promised program and other disabled assistance programs overseen by the state.

''We're evaluating this for possible legal action,'' said Mayes, adding that the U.S. Supreme Court has said such services must be provided ''in the least restrictive environment.''

''Medicaid is stalled on disability issues,'' says Paul Gowins, a member of the Nevada Disability Forum. ''The disabled community doesn't believe anything they say on these issues because there's no action.''

''We run around to a lot of meetings which is fine,'' Gowins adds. ''But when the meetings don't produce any fruit, maybe we need another tree.''

Critics of the delays had blamed Janice Wright, head of the state Division of Health Care Financing and Policy. She told lawmakers last spring that services for the physically disabled could be expanded without having to drastically revamp the existing Medicaid waiver program.

Now, Wright's boss, state Human Resources chief Charlotte Crawford, also is finding herself in the spotlight as legislators raise questions about various Medicaid programs within her agency.

The delays and the complaints prompted the Legislature's interim subcommittee on health care to send Gov. Kenny Guinn a letter in January urging action.

But the panel, chaired by Assemblywoman Ellen Koivisto, D-Las Vegas, was told at a meeting Tuesday that nothing has happened.

Jan Gilbert of the Progressive Leadership Alliance of Nevada said the 1999 Legislature appropriated $1 million to help keep disabled people out of institutions, after the state failed to use $500,000 approved by lawmakers in 1997 for a similar effort.

''This is a disservice to these people,'' Gilbert said. ''It's quite sad. They're still in nursing homes instead of their own homes.''

The physically disabled waiver program is a small part of a $500 million-a-year Medicaid program run by the state. In addition to helping people, advocates said it would save money by getting more people out of costly institutions.

Wright said a waiver amendment request was sent in January to the federal Health Care Financing Administration, but was returned in April for ''clarifications.''

Since then, there have been a series of phone calls and written responses from the state to HCFA. Staffing changes at the HCFA regional office in San Francisco also caused delays, she said.

''It's not on the back burner,'' Wright said. ''It's critically important to all the physically disabled as it is to Medicaid, and we're doing everything we can.''

Crawford said the state has used other funds to help about 20 disabled people get extra assistance while awaiting approval of the waiver amendment, so there's ''good news as well as bad news.''

But Crawford added that in dealing with ''a plethora of rules'' on waivers and amendments, ''minor changes don't take any less time than major changes.''

''We're still achieving part of the goals - but not as rapidly.''