The lawsuit is about Idaho's Medicaid program for adults with intellectual and developmental disabilities.
There was a lawsuit filed in Idaho that is known as K.W. v. Armstrong. It is called K.W. because those are the initials of one of the adults with a Developmental Disability (DD) who filed the lawsuit against the Idaho Department of Health and Welfare. You are part of the lawsuit because Medicaid pays for supports and services to help you live the life you want in the community. Because of this lawsuit, Medicaid started a project to make changes to the Adult DD program. The changes are listed in the Settlement Agreement.
Medicaid was asked by the court to change the way they do some things in the Adult DD program. Below is a list of the things Medicaid is working on changing:
- Medicaid is changing the way they figure out how much it costs to support you in the community. Medicaid will work with you to understand the process.
- Medicaid is changing the process to make it easier for you to make changes to your supports in the community or ask for money to pay for those supports. You can ask your support broker (SB) or targeted service coordinator (TSC) to help you with this request.
- If you want to see your assessment or anything related to your assessment, your SB or TSC can help you request those from Medicaid.
- Medicaid will pay and train SBs and TSCs to be suitable representatives who can help you file an appeal if you don’t agree with your budget.
- ACLU Letter - News About Your Developmental Disability Services.
Development of the new supports budget model
- Medicaid is working with the Human Services Research Institute (HSRI) to develop a new way to figure out how much support you need and how much those supports will cost each year. The new way will be called a “supports budget model.” A supports budget model is another way of saying the amount of supports you need to live the life you want in the community. It will take Medicaid at least two years to develop the new supports budget model.
- As part of this process, Medicaid will begin using the Supports Intensity Scale-Adult (SIS-A) instead of the Scales of Independent Behavior-Revised (SIB-R) to find out what supports you need to help you live in the community.
- ACLU- Why you should take the SIS
SIS-A Frequently Asked Questions
SIS-A Informational Briefing
- If you do not agree with your annual supports budget, you can chose to have someone help you with a budget appeal. Anyone can help you file an appeal. If you need help filing your appeal, Medicaid will pay a suitable representative to help you. A suitable representative is a SB or TSC that has attended required training. The training will teach them how the supports budget model is used, how to request an appeal, and how to prepare for a hearing.
Requesting a Budget Appeal Instructions
- Blank Form Suitable Representative Contract
- The letter that tells you how much money you can use for Medicaid supports and services is called a "budget notice". If you feel you need more support due to a health or safety concern, you can send information to Medicaid to tell them what support you need and why.
- You may get more money for supports and services if you have a health or safety need. To show that you have a health or safety need, you will need to fill out papers and give them to Medicaid with your budget appeal or when you submit your service plan for approval. Click here for a definition of Health and Safety. You may have a suitable representative such as a trained SB or TSC help you with this task.
- Self-Directed Exception Review for Health and Safety Needs Instructions
- Traditional Exception Review for Health and Safety Needs Instructions
- While Medicaid is working on the new process, your budget will remain at the highest level you have received on or since July 1, 2011. This is called your Injunction Budget. Later, when the new supports budget model is ready, everyone will get a new budget for support using the new process.