Opinion ID: 2653500
Heading Depth: 2
Heading Rank: 2

Heading: Leslie McCool

Text: ¶ 13. Leslie McCool has been eligible for home-based long-term care through Choices since 2004. She is in her mid-sixties, disabled with multiple sclerosis and diabetes, and living with her son. In August 2011, DAIL reassessed McCool’s Choices plan. McCool requested 152.5 hours of personal care services every two weeks. DAIL declined to approve more than the 115 hours of personal care services per-two week period that she had received in previous years. McCool did not appeal DAIL’s determination but sought reconsideration of DCF’s calculation of her monthly patient share. DCF issued a decision on December 7, 2011 confirming her patient share without change. ¶ 14. McCool appealed DCF’s decision to the Human Services Board. Following a fair hearing, the Board approved the hearing officer’s proposed findings and order recommending that DCF’s decision be upheld. The Board ruled that McCool did not meet the criteria to allow personal care services for general supervision and that her patient share could not be reduced based on a deduction for additional personal care services for ADLs because such services were coverable under Medicaid. The Board stated that McCool had the option of asking DAIL to reassess her needs before her next annual review and then appealing DAIL’s decision if she was not satisfied. ¶ 15. Petitioners Brett and McCool each appealed from the Board’s rulings, and we consolidated the two cases for purposes of briefing and argument. In their consolidated brief, petitioners argue that DCF’s decision not to deduct from their respective patient shares necessary medical expenses for personal care services denied by DAIL conflicts with Brett and federal law. In response, DCF argues that: (1) DAIL determined in both cases that the requested additional personal care services were not medically necessary; (2) those determinations became final when petitioners failed to appeal them; and (3) because the requested services are not medically necessary, payment for the services may not be deducted from petitioners’ patient shares. In a separate argument on which DCF takes no position, McCool argues that she is eligible for in forma pauperis status on appeal.