By DAVID ADAM
Herald-Whig Staff Writer

MONROE CITY, Mo. -- Three times a week for about 4 1/2 hours each day, Cliff Talton gets dialysis treatments at Hannibal Dialysis. He's been receiving those treatments for the last eight years.

Missing one isn't an option.

"We've got to have that treatment," Talton said. "If we miss treatments, we're in for it. You won't last long if you miss a treatment."

Occasionally a family member or a friend takes Talton to his appointment, which starts at 6 a.m., but typically he gets a ride from the Older Adult Transportation Service (OATS). The cost for a one-way trip to cover the 18 miles from Monroe City to Hannibal is around $15, and the state's Medicaid plan has helped cover that expense.

However, beginning July 1, the state plans to implement changes that will result in Talton and many people like him to lose that Medicaid-covered transportation to dialysis centers. Talton, four St. Louis-area residents and Paraquad, a not-for-profit advocacy group for the disabled, sued state officials in federal court last Monday in Jefferson City.

The plaintiffs say in their suit that the loss of that transportation will mean they won't get their dialysis treatments unless they are moved into a Medicaid-funded nursing home, and the costs of living in a nursing home would be more expensive for the state than paying for the transportation. The suit claims the state is violating the Americans with Disabilities Act if it implements the new policy, because the policy will deny people the opportunity to receive the same services in their homes as they would in a nursing facility.

"I'm not just doing this for myself. I've got friends in the same boat I'm in," Talton said.

The other plantiffs are Cedric Booker, 57; John Dobson, 76; Annies White, 84; and Eddie Earl Jones, 63.

Talton, 69, was a part-time police officer in Monroe City, worked at Underwood's (now General Mills) in Hannibal for 22 years and also served on the city council for 12 years. He's the father of eight children and has 24 grandchildren. Trouble with hypertension, blood pressure and diabetes caused his kidneys to fail, leading to the need for dialysis. He needs a walker to get around but is unable to drive.

The state plans to implement changes to its spenddown rules, which are similar to an insurance premium, for Missouri HealthNet Medicaid coverage on July 1. Missouri Healthet helps cover medical costs for aged, blind and disabled people.

In the past, once Talton received his first dialysis treatment of the month, he would meet his monthly "spenddown." Now, the state will use Medicare fee schedules, history, information from providers and Missouri HealthNet to "estimate" the amount of reimbursement allowed by Medicare, then apply deductible and co-payment amounts that are the patient's responsibility toward the spenddown amount. This process will prohibit Talton from meeting his spenddown and exclude him from transportation benefits.

"The problem is that Medicare may not get back to you for six months for what you're liable for," Heather Navarro, a St. Louis attorney representing Talton, said.

"Until now, Medicare and Medicaid have worked it out, and people have got their services on time. Now people are going to guess what he is liable for, and from treatment to treatment, Cliff isn't (going to be) sure if a car can pick him up, because he doesn't know if he's eligible for services."

The suit seeks a federal judge's order that would force the state to cover the transportation services and a preliminary injunction preventing the July 1 change.

Rebecca Woelfel with the Missouri Department of Social Services said the agency would not comment on ongoing litigation.

"I don't hold grudges, and there are a lot of things that the state does to help people out," Talton said. "Now, we're trying to get this help, but (the state's) doing it the wrong way. I don't want to say the state doesn't care about us, but that's what it looks like. Us dialysis patients, we don't know how long we have to live. I'm one of the blessed ones. I've been pretty sick, but God's still got work for me to do."

The idea of moving to a nursing home so he can get the transportation needed for his dialysis treatments does not sit well with Talton.

"I'm not ready for a nursing home," he said. "My wife is here in my home. My family is here. I'm still making payments on my house. It just really sounds foolish to me that they might have to put me in a nursing home. My wife and I have been happily married for 43 years, and now they want me to go to a nursing home? That would be more of an expense for the state than it is now.

"I'm not going to give up. Chances are slim, but I've been praying and putting it in God's hands. It just might be tough to find something that will work out. I hope the state knows they're playing with our lives."

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