We have asked the Governor of Nevada to open up cost-effective homecare resources and allow innocent people, like those in this video, to be released back into their home and community settings. Please, you can also speak up for them.

Governor Brian Sandoval is avoiding addressing embarrassing issues concerning homecare in Nevada.

How does wrongful institutionalization of people with disabilities and of our elderly keep going on?

People with disabilities are protesting Nevada Medicaid policies that cause unnecessary institutionalization. The Governor of Nevada avoids facing them.

They are protesting for these three minimal requirements to stop unnecessary institutionalization and establish self-directed homecare.

 

Your legal assistance or media exposure can help greatly.

Here is your introduction and latest detailed update.

Dear –Civic Minded Atty.,
Could you contribute a few hours of your services to help a certain unrepresented class of elderly and disabled persons?  (One other prominent attorney has promised to help.)  These are a small group of indigent people who are dependent on Nevada State Medicaid.

 They are being discriminated against in two related ways.
The heaviest aspect of the discrimination is that several people have been, or are currently institutionalized, unnecessarily, against their wishes… Some of these have suffered this for years! 

The State of Nevada has neglected to take key opportunities to fix this serious problem.  Also, contrary to the US Supreme Court Olmstead ruling, Nevada has no "comprehensive, effectively working plan" to reasonably stop what the Court determined is "discrimination".  (The State has created a guise of a, "Strategic Plan" that is non-obligatory and proves itself inadequate.)

 These debilitated people require homecare and other "home and community-based services" to survive outside of a convalescent facility.  Currently, Nevada Medicaid and the Gov.'s Office are withholding at least one homecare resource, which for some of these people, would facilitate their release back into their communities.  The use of Independent Caregivers, (individual homecare providers), is withheld, with discrimination, from the majority of Medicaid eligible people. 

  I am one of the few privileged who are allowed to enjoy this cost-effective homecare. Over the years, I have gone through the ranks of the state.  Medicaid administrators, Health and Human Services director Michael Willden, and now the Gov.'s Office, have all rejected my countless pleas to stop the discrimination.  

 I have exhausted my every means to persuade the State to do better.  I believe only political embarrassment, public outcry, or legal force, must be applied before the State will be persuaded to help these people and comply with the law. 

 Whether or not you have any experience with disability or discrimination law, you can help relieve the unnecessary affliction suffered by many disabled/elderly people.  Are you willing to help in any capacity?  Here are three ways you might help:

1. Simply give your comments about the things you read in this letter.  This would be genuinely appreciated. Please e-mail me at: [email protected].

2. Validating the applicability of the laws mentioned in this overview. Of course, this would require more time on your part.

3. If it proves appropriate and necessary, please consider sharing in the representation of a legal action against the State.

 If you are willing to help in any capacity, or have any questions, please call me at 775-356-5351.

Thank you,
Rick Cline

 

Hello Newsperson,
Please look into this story about an ongoing struggle to persuade Nevada Medicaid administrators and Governor Sandoval, to eliminate ongoing, wrongful institutionalization and allow fair and equal access to alternative, recipient-directed homecare.  

Could you review this letter, the links, and especially see the 4min. video? You can find the video and more links with additional information at Please-Speak-Up.com. The video is of two unnecessarily institutionalized elderly people pleading to the Gov. for help. 

After a year, Gov. Sandoval is still dodging the questions about the discriminatory policies and is not willing to correct the problem.   After reviewing the letters and video and if you have interest in this story, will you contact the Gov.'s Office for their comments?  Also, please contact me at 775-356-5351.  I believe just a call from you might alert them to properly address the ongoing discrimination.

 I met with Gov. Sandoval's  Deputy Chief of Staff Jackie Bryant about these policy problems (May 23).  She asked me to get her a related brief from Attorney Bill Peterson.  My letter to Mr. Peterson, requesting his help, is below.  

 Also below are the pointed questions I left with the Ms. Bryant. (The Gov.'s Office is afraid to answer those questions.  I hope you will ask the same revealing questions.)  Lastly included, is a letter addressing the Governor's back-room edict to continue with existing policies.  He made that decision, while knowing the policies may be discriminatory and that some elderly are being harmed. 

 All this should give you an up-to-date insight into the story.  Thank you for your time to look at this complex but important story,
Rick Cline


 

Hello Bill,
  I am recovering from a serious bout with pneumonia.  I was hospitalized for several months.  When I realized I might not be recovering, I took account of my life and my lack of progress in the battle to secure a better state for our elderly and disabled persons in Nevada.  Now, although considerably weaker, I am more determined than ever to see the overdue changes. 

 I should more intensely fight with the meager means I possess… I will now seek press involvement, organize more public protests, and expand Internet exposure of this harmful discrimination against these people.

 Your name came up as I met with Jackie Bryant, (Deputy Chief of Staff).  She asked me to send her the brief you wrote concerning the absence of an employer-ship liability when the State uses the independent homecare contractors/providers.  Could you please contact her at the Governor's Office, 684-1670? 

 I recognize the State has ample legal resources to almost endlessly manipulate and argue legal points to shroud their violations of law, (two of which are specifically pointed out in the questions attached below).  I'm hoping you will still be available to advocate these issues, against the State if necessary. 

 Thus far, the Governor's Office has gone along with the decisions of Mr. Willden and of other Nevada Medicaid administrators in these violations.  These are more than mere infractions of law.  They amount to a discrimination that has brought genuine hardship upon several vulnerable people throughout the state.  The Governor himself has been apprised of these infractions and the suffering.  Perhaps you might persuade Ms. Bryant to recommend to the Governor a different course of action.

Governor of Nevada, deputy chief of staff, Ms. Wilkinson
A disability advocate points out to Gov.'s staff that
the State's means of stopping the ongoing unnecessary institutionalization, are simply not working. "The State is unjustly warehousing our elderly and persons with disabilities."

Eight months ago, I appealed to the Governor to initiate three remedial steps to stop the unnecessary institutionalization.  Their answer was, "No… We have our own means."   I intend to further urge the Governor to initiate immediate help for the unnecessarily institutionalized individuals in this video, as well as for the others who have already, directly appealed to him concerning their being deprived fair and equal access to use independent homecare providers.

 The bottom line is the state is breaking the law and harming real human beings.  The Governor could instead exercise outstanding leadership by correcting the discrimination.  I'm writing in hopes that you might convince them of the legal and moral value of helping these people.
Thanks, Rick.


I left the following eight questions off with Jackie Bryant on May 23, 2013.  The Gov.'s office is still refusing to answer any of these questions:

Concerning the Elderly Pleading with the Governor for Help to Escape Unnecessary Institutionalization:
1. Has he said or done anything to help them, since the video was brought to his attention last year?                                           Governor Not willing to answer.
2. Does the Governor have any intention of helping these people… Plus the others who are unnecessarily institutionalized?             Governor Not willing to answer.
3. Does he share our disdain for the ongoing discrimination in the ministration of the independent caregiver program? (The Medicaid administration acknowledges the majority of Nevada Medicaid recipients are now deprived equal choice and access to Independent Caregivers.)
Governor Not willing to answer.

Concerning Independent caregiver program, Nevada Medicaid 58 PROVIDERS, (These are individuals who are already contractually authorized by the State as homecare service providers.)
4. Will the Governor commit to providing fair and equal access in all state programs, including all eligible Nevadans who are elderly or disabled?  Governor Not willing to answer.
5. If not, on what basis is the State exempt from the federal law* which require the State provide its Medicaid services in an evenhanded manner?  Governor Not willing to answer.
6. Does an unsubstantiated fear of liability, make it okay to ignore these people in their plight and also override equality laws?        Governor Not willing to answer.
* 42 USC § 1396a (10) (B) (i), "A State plan for medical assistance must— provide— that the medical assistance made available to any individual… shall not be less in amount, duration, or scope than the medical assistance made available to any other such individual…"
Also, the vast majority of those who are authorized for homecare services, are not allowed the choice to use independent homecare providers. 
7. Doesn't this violate the federally guaranteed freedom in choice of service provider law, [42 U.S.C. 1395a]?                                          Governor Not willing to answer.
It states, " Basic freedom of choice.—Any individual entitled to insurance benefits under this title may obtain health services from any institution, agency, or person qualified to participate under this title if such institution, agency, or person undertakes to provide him such services."
8. On what legal basis can The State now exclude these individual providers, who are otherwise formally authorized homecare providers, from a recipient's guaranteed choice of service provider, which by the statute, is suppose to include "persons" who are willing providers?  Governor Not willing to answer.

After my May 23 meeting with Ms. Bryant, she promised to meet with me again the first part of July.  Instead, she called me with their final response; apparently they are not going to change any policies.  The Deputy Chief of Staff told me, "The independent caregiver program would remain closed off to other participants, but that I was grandfathered in and if I knew of anyone who felt discriminated against, I could have them call her."  I was thankful for her concession but I objected, "Wouldn't that merely satisfy a few and be neglecting the others that might really need the homecare service?"

She was also unwilling to answer that question, but also has threatened the program could be eliminated.  After that conversation, I sent the following response letter.  It points out another equality law the State is violating and asks the Gov., why he would not take a stand for these vulnerable people… Still, Not willing to answer.

Regarding Elder & Disability Discrimination in Nevada
July 1, 2013

Gov. Sandoval and Ms. Jackie Bryant,

After considering our conversation this morning… It is not in sync with integrity to neglect most of the vulnerable people in the state who are deprived equal participation in the independent caregiver option.  (Governor, why won't you stand up for these people?)  Now, I should work harder to emphasize the fallacies and overall harm of this inappropriate policy decision. 

As I mentioned, here is another reference to federal law that addresses equal participation.  Currently, the State admits it limits the privilege of using independent homecare providers, (called 58 PROVIDERS).  Administrators' explanations have regularly changed, (nothing found in current, written policy).  But now they say, "It is limited to those who are unable to participate in some other type of homecare service." The benefit is not allowed for any would-be participants, some of whom are now unnecessarily institutionalized.

In § 35.130, the General prohibitions against discrimination (b) (1), (vii), it states that…

In other words… Nevada Medicaid, in its administration of this program/service, may not limit, in any which way, any eligible Medicaid recipient with a disability, from enjoying the privilege of using the Independent Caregivers, which privilege is now enjoyed by others receiving the service.

Almost always, there is a way for a brilliant lawyer to present argument to circumvent the intended impact and purpose of a law.  The purpose and spirit of this law is to ensure fair and equal treatment for people with disabilities.  In an effort to save face, will the State now argue to avoid the corrections that embrace this law's purpose?
Is projecting an image of flawlessness better than accepting correction?  Everybody already knows the Governor is human and that Nevada Medicaid is not flawless.  Please appropriately make the rudimentary changes to put a stop to unnecessary institutionalization and bolster recipient-directed home care in Nevada. 
May God bless you in taking such action,

Rick Cline