October 24, 2005.
JEFFERSON CITY - Unlike most disabled adults on Medicaid, the blind can get state-paid wheelchair batteries, pressure-relieving cushions and hearing aids.
The blind can get their teeth cleaned and dentures fitted. They can go to a podiatrist for foot problems and see a physical therapist for help with injuries. They can even get eyeglasses.
Though no one is saying the blind don't deserve help, some question whether it's fair to single out one disability when other low-income adults lost coverage for specialized services and equipment when Medicaid cuts took effect Sept. 1.
"I'm happy for the blind folks, that they got the exception, but I don't necessarily think it's right," said Rich Blakley, who runs a center that helps disabled people in Iron County. "To me, a disability's a disability."
Whether the blind should be treated differently is at the heart of a federal lawsuit contesting the Medicaid cuts. The suit, filed by seven disabled people, contends it's illegal to provide medical equipment for some needy people but not others.
David B. Gray, an expert in the case, said in a court document that he can't fathom why blind people require special cushions to prevent bedsores more than people with cerebral palsy. Gray, an associate professor of occupational therapy at Washington University, has been a quadriplegic since an accident 30 years ago.
State officials contend specialized services are optional under federal law, so the state can choose who gets them. The state has asked U.S. District Judge Dean Whipple to dismiss the suit. The request is pending.
Gov. Matt Blunt's administration, which proposed the exemption for the blind, says tradition underlies the decision.
Since the 1920s, the state has provided monthly cash benefits - called pensions - to blind people. And since the 1950s, the state has picked up their medical bills.
"Historically, under Missouri state statute, the challenge of the blind has been acknowledged through the establishment of the blind pension fund," said Deborah Scott, spokeswoman for the Department of Social Services, which runs Medicaid.
State voters set up the pension fund through a constitutional amendment "to help people with really restricted vision get along in the workplace," said Janel Luck, interim director of the Family Support Division. The idea was to offset the cost of guides, readers and taxis.
Today, the pension fund pays out more than $20 million a year to about 3,650 people who are 18 and older. The money comes from a small statewide property tax. Most recipients receive $510 a month. Smaller checks go to those who qualify for federal Supplemental Security Income benefits.
Elizabeth Moore, 48, of St. Louis, lost one eye to a hemorrhage as a teenager and developed glaucoma in the other eye. She doesn't work but plans to attend college in January. She said the state assistance keeps her afloat. She relies on Medicaid for a power wheelchair, a nebulizer and a caregiver's help.
"I would be in big trouble" without the benefits, she said.
To qualify for pensions, people must be totally blind, not just legally blind. They can have no more than 5/200 vision or a visual field of less than 5 degrees. Legal blindness is 20/200.
There are also several old-fashioned criteria that reflect the law's 1920s-era origin. Pension recipients must:
Be of good moral character, a trait that can be verified with a written statement from a fellow Missouri resident.
Not publicly solicit alms.
Be willing to have an operation if a cure is found.
The blind person and spouse can accumulate no more than $20,000 in savings or property, not counting their home. But there is no income test. That's another way the blind are treated differently.
Regular Medicaid has strict income caps. Because blind pensioners aren't held to income standards, the state can't draw federal matching funds to cover their health care. The state picks up the whole cost - nearly $24.4 million last year.
Separately, some blind people do meet federal income criteria. Their health care - costing $12.1 million - is paid from state and federal money. Sen. Chuck Purgason, who sponsored the bill cutting Medicaid services for most adults, couldn't recall any debate about exempting the blind.
"We never dealt with it," said Purgason, R-Caulfield. "It's not a huge cost-driver for the state."
Rep. Margaret Donnelly, D-Richmond Heights, said Democrats didn't question the exemption because they didn't want to cut any disabled group.
"Can I give a rational reason for it? No," Donnelly said. "I do think we have legal problems with it because I don't think you can take individuals in one category and give them favorable treatment."
But being singled out is nothing new for the blind. On the federal level, blind vendors have received priority in government buildings since the 1930s. The blind have enjoyed a special federal tax deduction since 1943.
Beverly Armstrong, executive director of the Missouri Council of the Blind, said state officials may have preserved services for the blind to avoid a fight. The council has aggressively fought for bigger pension checks, suing the state last year over the way benefits were figured.
"I think they were hopeful that we would go away if they left us with our Medicaid," Armstrong said.
Instead, what could go away is specialized services.
If the state loses the legal battle, the Department of Social Services says, medical equipment won't be restored for adults with other disabilities; it will be eliminated for the blind.
The state of Missouri provides Medicaid to the blind under:
The Blind Pension Fund: Recipients must be at least 18, with less than $20,000 in property not counting their home. They must be totally blind. There are 2,826 people in the program. The state paid about $24.4 million last year for their health care.
Supplemental Aid to the Blind: Recipients must be at least 18, with less than $2,000 in property not counting their home. They must be totally blind and receiving federal Supplemental Security Income benefits. There are 816 people in the program. The state and federal governments paid about $12.1 million last year for their health care.
Source URL: http://www.stltoday.com/stltoday/news/stories.nsf/stlouiscitycounty/story/8D1FB111EFB3462B862570A4004F4E40?OpenDocument.
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