LOUISVILLE, Ky. — Two Nepalese immigrants in Louisville dreamed of opening a home healthcare business for their growing community of refugees. But the state told them it was “not allowed.” So they filed a lawsuit against the state.
Dipendra Tiwari and Kishor Sapkota say they saw their Nepali-speaking community needed help. They say many of their neighbors aren’t getting the medical attention they need because of a language barrier. Many also don’t have cars or licenses, so it’s hard even getting to their appointments.
They called their business Grace Home Care. The goal is to help their neighbors avoid nursing homes by getting them the care they need at home. And they saw themselves as a perfect team to make a difference: Sapkota is a state-registered nurse aide and Tiwari is an accountant.
Dipendra Tiwari (right) and Kishor Sapkota (center) are working to create a home healthcare program for Nepali-speaking immigrants.
“We were very excited,” said Tiwari.
The duo quickly ran into a problem. Under state law, healthcare businesses must first get what’s called a “certificate of need” to operate, proving they’re not duplicating what’s already available. Sapkota and Tiwari requested the certificate, but the state denied their request.
In early December, they filed a lawsuit against the state.
“People who need the service aren’t getting the quality service because there’s no competition,” said Tiwari.
“We need to fight against this discrimination,” said Sapkota.
Chitra Katwal suffers from a worsening lung disease. She doesn’t have a car or driver’s license to go to the doctor and she doesn’t understand English. The home healthcare system proposed by Dipendra Tiwari and Kishor Sapkota would help people like Katwal.
The Kentucky Hospital Association says the “certificate of need” law ensures an appropriate level of services is available to communities statewide.
“You put too much services out there and they become inefficient,” says State Representative Tom Burch, a proponent of the certificate of need law.
But Tiwari and Sapkota, who still dream of their own home healthcare business, argue their community is not getting what it needs. They say it’s why the law should be abolished.
“The government picking winners and losers in the marketplace like this is unconstitutional,” said attorney Andrew Ward, who is representing Tiwari and Sapkota with nonprofit Institute for Justice.
This map shows the states that require a “certificate of need” for home healthcare programs. Source: Institute for Justice
In Jefferson County, where the entrepreneurs hope to operate, there are nine licensed home healthcare facilities, according to the Kentucky Cabinet for Health and Family Services. That’s for a population of about 771,000 people.
Across the country, according to Institute for Justice, Kentucky is one of 16 states and the District of Columbia with laws blocking new home healthcare businesses from opening unless they show there’s a need for them.
“These laws raise costs and make the system worse,” Ward said.
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