Newsome is a developmentally disabled adult receiving services through the HCBS Medicaid Waiver Program, implemented by the Agency for Persons with Disabilities (APD). Her services cost approximately $72,000 per year. The waiver program assigns eligible individuals to one of four statutorily defined tiers based on the nature and extent of the individual’s service needs and is intended to balance the delivery of services to eligible individuals with the availability of appropriated funds.
APD assigned Newsome to Tier Three, which has a $35,000 expenditure limit, because it determined her needs could be met by that tier. Tier One, with no cost limit, was limited to individuals who have intensive medical or adaptive service needs that cannot be met in the lower tiers. In reasoning that Newsome’s service needs could be met in Tier Three, APD did not consider any services in her cost plan other than the amounts for personal care assistance, and waiver support coordination which was less than the Tier Three expenditure. APD did not consider the costs of her other services because they were not listed in rule 65G-4.0027(4), defining Tier One criteria.
Newsome appealed the assignment. The appellate court stated that APD was wrong and that 65G-4.0027(4) did not limit consideration of the client’s needs to only the services listed in the rule. The listed services were to be used as the primary basis for tier assignment, not the only ones. APD’s final order was reversed.
Newsome v. Agency for Persons with Disabilities, 2011 Fla. App. LEXIS 18596 (November 22, 2011)
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