"Withhold not good from them to whom it is due, when it is in the power of your hand to do it."

February 22, 2012
Dear Gov. Sandoval,

I can understand your reliance on Mr. Duarte and Mr. Willden to administer state Medicaid issues.  But at times, they have overlooked the well-being of those affected by their policies. There is an ongoing mishandling of the Independent Caregiver* home care services, (called 58 PROVIDERS).  In this, they are neglecting people and law…

• They are now excluding those providers from equally participating in the provision of home care services. This violates federal Medicaid rules and seriously hampers fair competition.  (In so doing, administrators are withholding "Guaranteed Freedom of Choice in Providers", from almost all Nevada Medicaid homecare recipients.)
  
  
• Not Mr. Duarte, nor Mr. Willden, will deny they are applying this policy of un-evenhanded treatment of people with disabilities.  That is, they overtly deprive equally eligible Medicaid recipients, fair and equal access to the same home care option others benefit from. (The comparability requirement of the Medicaid Act provides that the medical assistance available to any eligible individual "shall not be less in amount, duration, or scope than the medical assistance made available to any other individual." 42 USC § 1396a (10) (B). )



• When confronted about that discriminatory practice, Medicaid administrators threatened me with a punishing downgrade of my current home care services. (Such coercion should never be permitted in any legal environment.  Also, although your office has said these administrators will not curtail my services, the ill intentions are still festering.)

Why go along with them; they are wrecking a completely operable, cost effective vehicle of home care.  More importantly, Independent Caregivers deliver people with disabilities greater independence.  Withholding, or further dismantling, this home care resource only serves administrators' laziness and the preferences of a few corporate healthcare companies.  In no respect does it serve our community as a whole.

A False Alarm Has Turned You from Appropriate Action… As an excuse for the civil rights violations described above, Medicaid administrators, and now your Office, are emphasizing a "concern" of possible employer-ship liabilities.  (Objective examination reveals that concern as incredibly exaggerated.  It is what your associate, Deputy Atty. Gen. Faircloth, refers to and rightly labeled, a "meritless" accusation.) 

Do you recognize the profound duplicity being applied?   On a regular basis, the State contracts with many individuals, with no such concern of any such employer-ship liability.  This is because the plain contract language, precludes that liability. You need not protect the state from false alarms but rather protect our civil rights and our well-being.

Please Sir, require compassionate wisdom be exercised in this issue… Protect and bolster person-directed, non-institutional home care. (It would be a demonstration of good leadership nationally.)  Don't withhold this good from Nevada's most vulnerable people… while it is in your power to do so.

Thank you,
Rick Cline

*All without any additional state monies, Independent Caregivers have already proven to be a good service for our community…

• They bring some very vulnerable people greater independence and a safer environment.
• This form of home care fully complies with federal mandates to provide the least restrictive most integrated setting for people with disabilities. 
• The option delivers a livable wage for the caregivers. (They receive 30% higher wages, at an 8% lower cost for the state.)
• So, it lends to higher-quality, more career-oriented caregivers.
• It brings in a much-needed competition for state-funded, corporate homecare services.