Hope for families whose extra care budget has been rejected: assessment must be different
The ruling has direct consequences for other families whose requests for additional care were rejected, and for the way care offices assess applications for additional care. According to the judge, the assessment method is too unclear, and the level of care and the number of hours required must be re-examined.
The Ministry of Health, Welfare and Sport (VWS) and the healthcare insurers are currently working on new policies. Until then, Menzis and CZ will postpone assessments in cases where there is still uncertainty and will temporarily extend the allowance.
RTL Nieuws previously reported that dozens of families are struggling due to the loss of additional care. The difference amounts to over €100,000 less per year. The healthcare providers Menzis and CZ were mentioned most often at the time.
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For Dienke, the Central Appeals Tribunal's ruling is a huge relief. "We're thrilled that the application is being reconsidered. Not just for us, but also for others in the same situation."
She filed this case after her stepfather's request for additional care was rejected. He suffered a stroke in 2022 and was in a coma for a long time. Since then, he has been partially paralyzed and requires extensive care. "My mother does a lot herself, but she's also struggling. It's terrible to see."
Still, the tension isn't entirely over. "The ruling really boils down to a different assessment method. But that doesn't mean you'll automatically be awarded the additional care. That will also depend on the new policy," explains attorney Matthijs Vermaat of De Graaf aan de Kade Advocaten.
Lawyer Vermaat and social lawyer Lucia van Milaan are jointly representing ninety families whose applications for additional care have been rejected.
To the judgeIf an application for additional care is rejected, it's possible to file an appeal. For those who have already gone through the appeals procedure and received a final rejection, nothing changes yet. If they want the healthcare office to reconsider their case, they must initiate legal proceedings. This can be done within six weeks of the rejection. Otherwise, a new application must be submitted, and the process starts over.
The Ministry of Health, Welfare and Sport (VWS) has stated that they want to provide more clarity quickly and ensure no one waits longer than necessary. They aim to provide Parliament with further information in December.
People with severe disabilities receive a fixed amount for their care under the Long-Term Care Act (Wlz). For those who arrange care at home for a disabled child, partner, or family member, this amount is sometimes insufficient. In such cases, the care office can grant the Extra Costs at Home allowance. If this allowance is insufficient, additional care can be requested. This is the additional allowance for the most intensive care.
A care agency manages care for people with a Long-Term Care Act (Wlz) indication. If someone wants to manage their own care, the care agency can grant a personal budget (pgb). There are seven care agencies in the Netherlands, each responsible for its own region.
Stefan's application was also suddenly rejected. He cares for his wife at home, who suffered a brain hemorrhage, and is still awaiting the appeal process:
