Chronically ill home care recipients in New York are suing the state in federal court, charging that following the state’s shift to Medicaid managed care their services are being denied or reduced without notice, appeal rights or even an explanation.
The suit, filed in United States District Court for the Southern District of New York, names three plaintiffs who “are representative of thousands of New Yorkers who struggle with severe health conditions and depend on Medicaid-funded care, but are now having their services reduced or discontinued without adequate notice or the opportunity for a Fair Hearing, as required by law,” according to the New York Legal Assistance Group, which brought the suit.
In 2011, New York State began the process of shifting $6 billion in Medicaid spending on long-term services to private managed care companies. Advocates for the elderly and those with disabilities have maintained that companies have been cherry picking only the most lucrative enrollees. The suit, according to an article in The New York Times, “takes these complaints to a new level, charging that the state is now allowing companies to quietly reduce or terminate home care to people whose need for services has not changed, without giving them a meaningful chance to object.”
The lead plaintiff, Janie Taylor, is an 84-year-old woman who lives alone in Manhattan and who suffers from numerous medical conditions including a mobility impairment and who had been receiving home care services 10 hours a day, seven days a week. In March 2013, Ms. Taylor was mandatorily enrolled in a VNS CHOICE plan. The plan initially maintained her home care, but on July 1, 2014, VNS CHOICE cut her services in half without notice, to 5 hours a day. The reduction was erroneously characterized as a “new authorization” and she was not advised of her right to an appeal or request a hearing. She contacted lawyers, who requested a fair hearing, but her hours have not been restored pending the outcome.
For a statement from the New York Legal Assistance Group, which brought the suit, click here.
To read the complaint, click here.
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