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The programs at issue provide in-home help for thousands of Alaskans with the basics of life, from medication to meals. The goal is to help people stay in their own homes rather than go into nursing homes or other institutions.
The services are paid for by Medicaid, the state-federal health program for the poor and the disabled, and overseen by the state Division of Senior and Disabilities Services. Individuals qualify based on income and need. Private contractors do most of the work. The programs cost about $250 million this year, with the federal government currently paying 61 percent of the bill.
Two broad categories of programs are at issue: One, providing just personal care, serves 3,200 people and the other, with a broader range of services including home health care, helps about 3,800 through what are known as Medicaid waivers. Some clients get help through both types of program.
Division officials on Tuesday acknowledged serious problems, including a backlog of about 2,000 people waiting for a nurse assessment to determine what services they need. They said fixes are coming.
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In March, the state told officials with the federal Centers for Medicare & Medicaid Services about the huge backlog of people waiting to be evaluated.
"That was the first red flag that went up for us, that something was going on there that was not meeting our expectations," said Mary Kahn, a spokeswoman for the federal agency.
"Rather than continue to let the state admit more and more people into what we believe has been a poorly managed system, we just said hold the phone, we're going to try to find other ways to serve these people," Kahn said. "And we're going to stop enrollment in this program because we are quite concerned."
State officials said some private agencies in Alaska provide similar services through grant funding. But advocates say those services are very limited.
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Another sign of trouble for the feds: eight lawsuits against the state division.
Most were brought by the Northern Justice Project, a private civil rights firm created in 2006 to pursue class action suits and other big cases.
"I think the lawsuits reflect that these two programs are and have been run incompetently for some time," said Jim Davis, one of the partners and founders of the justice project.
The common thread in the suits is that seniors and disabled Alaskans aren't getting the services they are entitled to, under the law, Davis said. In one big win, the state Supreme Court ruled last year that the state had improperly cut off or reduced services to more than 1,000 needy people.
State officials say they are trying to settle those lawsuits.
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II. FACTS AND PROCEEDINGS
A. Facts
In August 2005 the Northern Justice Project filed a
class action lawsuit against the State of Alaska on behalf of
Interim Assistance (IA) benefits applicants, alleging that an
internal policy the state adopted in 2003 to save costs violated
the Alaska Administrative Procedures Act (APA). IA benefits are
available to Alaskans who have applied for Supplemental Security
Income (SSI) benefits1 but who have not yet received a final
decision from the federal government on their SSI applications.2
To qualify for IA benefits, a state-approved physician or
psychiatrist must find the applicant disabled.3 If the federal
government finds the applicant qualifies for SSI benefits and
thus begins paying such benefits, the applicant must repay the
state for the IA benefits she received;4 if she does not qualify,
she is not required to repay the state.5 To reduce the number of
applicants who are not required to repay the state and thus save
costs, the state implemented an internal policy change in 2003
that added a secondary disability assessment. Under the 2003
policy, if the state-approved doctor found the applicant disabled
and eligible for IA benefits but a secondary medical screener
disagreed, the state denied the application. The state did not
follow the APA in promulgating this policy.
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In Friday's 3-2 vote, the Supreme Court ruled that the law infringes on a pregnant teen's rights to reproductive freedom. The decision backed a Superior Court ruling that found the law unconstitutional.
Chief Justice Dana Fabe wrote the majority opinion on behalf of herself and Justices Robert Eastaugh and Alexander Bryner:
"We decide today that the State has an undeniably compelling interest in protecting the health of minors and in fostering family involvement in a minor's decisions regarding her pregnancy," Fabe wrote.
"And contrary to the arguments of Planned Parenthood, we determine that the constitution permits a statutory scheme which ensures that parents are notified so that they can be engaged in their daughters' important decisions in these matters.
"But we ultimately conclude that the Act does not strike the proper constitutional balance between the State's compelling interests and a minor's fundamental right to privacy."
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