Opinion ID: 216365
Heading Depth: 1
Heading Rank: 2

Heading: Cohon's Mi Via Waiver Budget Determination

Text: Cohon is twenty-seven years old and legally blind. She has a medical history of cerebral palsy and autism. Compl. ¶ 10. Cohon's long-term care needs were assessed at Level 1, the most severe level of need in terms of the severity of her disability and the amount of care she requires. Id. ¶ 19. Cohon applied for Mi Via Waiver services under New Mexico's Home and Community Based Services Waiver provisions and was determined to be medically and financially eligible. Id. ¶ 11. Cohon met with Lovelace to compile a budget request. Cohon qualified for the IBA of $59,449 as a participant with no prior waiver experience who was developmentally disabled, over 21 years of age, and required residential support services. Cohon met the criteria for additional funding related to chronic or intermittent behavioral conditions or cognitive difficulties. Id. ¶¶ 20, 25. After meeting with Lovelace, Cohon submitted a proposed request for additional funding such that her total budget request was $116,080. Id. ¶ 27. After another meeting including some state employees and Lovelace, Cohon submitted a revised budget request of $106,667. Id. ¶ 28. Lovelace determined that the revised proposed budget of $106,667 would result in savings of $13,442.50 to the state as compared with the cost of a traditional waiver program for developmentally disabled individuals. Id. ¶ 29. On March 14, 2008, Cohon's proposed budget was partially approved in the amount of $97,007.24. Id. ¶ 34, 48. Cohon's proposed budget requests had been prioritized by the State Defendant's review committee without Cohon's input. Id. ¶¶ 33, 35, 37. The $9,660.44 in funding denied included Cohon's requests for funding for the following expenses: chiropractic and orthotic services, nutritional supplements, fleet enemas, ski lessons, swim punch cards, funds to attend non-local conferences and meetings (including registration, hotel, and a per diem), four DVDs, overnight care, care buddy merit increases, driver merit increases, community job advisor raises, and money in a reserve fund. Id. ¶ 36. Of the denied expenses, all but the per diem request met the Mi Via program's standards as expenses that could be approved. Id. ¶ 30. Had the budget requests not exceeded Cohon's IBA of $59,449, they would have been approved. Id. ¶ 42, 66. Cohon requested and, on July 30, 2008, was provided with an administrative evidentiary hearing concerning the denied budget requests. The administrative law judge determined that Cohon's budget requests met the criteria for Mi Via Waiver services, that Cohon's requests for chiropractic and orthotic services, nutritional supplements, and fleet enemas should have been approved, but that the New Mexico Human Services Department had the discretion to disapprove the other services. Id. at 2-3. On September 30, 2008, defendant Carolyn Ingram reversed the administrative law judge's determination that any of the additional budget requests should be approved and stated that, because the additional budget requests exceeded the Mi Via budgetary allotment, they had to be necessary to keep the participant safe in order to be approved. Id. at 3.