After a horrific car crash left him with a severe brain injury, Craig Minnix learned to call Walton West home. After a two-year battle, Mr. Minnix and his family finally have taught the state of Georgia to call the Augusta facility the same thing.
His apparent victory could have implications for an unknown number of other brain-injury patients.
"I'm excited about it; I'm pleased with it," said Cindy Minnix Saylor, Mr. Minnix's sister and advocate. "(But) this has gone on for two years, so I'm afraid to get too overly excited."
Mr. Minnix, 37, was one of four Walton West residential patients facing a cutoff in 1999 because the state decided its Independent Care Waiver Program would no longer cover their care there. The program allows Medicaid to pay for services delivered in a home setting, but the state decided Walton West did not fit its definition of "home." The Health Care Financing Administration, which oversees Medicaid programs and is responsible for granting the state a waiver, doesn't allow one to pay for services in an institution, which is how the state defined Walton West.
Mr. Minnix's family appealed the decision.
The state won the challenges and was upheld on final appeal earlier this year. But the family and attorneys from the Georgia Advocacy Office filed discrimination complaints with the U.S. Department of Health and Human Services' Office for Civil Rights.
After meeting with both sides, the civil rights office sent the state a letter saying that it hoped the complaints could be resolved without an investigation. The office pointed out that under the Americans With Disabilities Act, the state should provide care "in the most integrated setting appropriate" for the patient. In a Georgia case two years ago, the U.S. Supreme Court upheld the right of the disabled to be served in the community but found the state's responsibility "is not boundless."
After negotiations with the HCFA and the civil rights office, which are part of the same federal department, the state found it could change its interpretation and allow the waivers to be used in traumatic brain-injury treatment facilities, such as Walton West, said Mark Trail, the acting director of the Division of Medical Assistance, which oversees Medicaid.
"We want to get the right thing done," Mr. Trail said. That will be the state's policy going forward, which may aid at least three other patients who want to get into Walton West.
That is the family's hope, Mrs. Saylor said, that other families will be helped by their battle.
In the two years of appeals, Mr. Minnix has been allowed to remain at Walton West, where he has shown good progress, Mrs. Saylor said. Sitting around a table at Walton West with his family, he jokes and contributes to conversations, though it is often a stock phrase.
He remembers that his 8-year-old son, Cody, wants to play center field. He refuses to shave his beard for his mother, Bonnie, and he is doing his own laundry, with help.
It was five years ago when he nearly died in the car wreck that killed his father. It has been a long, slow struggle since then.
"It's been five years ..." Mrs. Saylor began.
"Of stuff," Craig added helpfully.
"Of battling to get him services," Mrs. Saylor said, looking at her brother. "Every step along the way."
Reach Tom Corwin at (706) 823-3213 or firstname.lastname@example.org.
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