Victory for Special Litigation Unit in Medicaid Home Health Care Case

NYLAG’s Special Litigation Unit won a significant victory in their case against the New York State Office of Temporary and Disability Assistance and the New York State Department of Health, (“State Defendants”), challenging delays in the provision of final administrative action after requests for fair hearings in the context of Medicaid-funded home health services. Judge Holwell certified the plaintiff class and awarded Plaintiffs’ summary judgment against State Defendants finding that they systemically violated the federal Medicaid Act and its supporting regulations by failing to provide final administrative action to Medicaid home health care recipients, in compliance with Decisions after Fair Hearings, within 90 days of requests for hearings.

Plaintiff Boris Shakhnes, who suffers from multiple sclerosis, waited more than seven months for State Defendants to even schedule a Fair Hearing after his doctor’s request for an increase in home health care was denied. Mr. Shakhnes’s suffering increased greatly during the many months he went without the care to which he was legally entitled. Jane Greengold Stevens, the Director of Litigation at NYLAG, explained that under the federal Medicaid system, “states are required to provide an opportunity for appeal through a fair hearing process for any individual whose claim for assistance is denied or not acted upon, or whose benefits are terminated or reduced. The State has failed to comply with its statutory obligations. This lawsuit is another example of NYLAG’s efforts to ensure at-risk population receive the access to justice to which they’re entitled.”

Finding that Plaintiffs have a right of action to enforce the applicable provisions of the Medicaid Act, United States District Judge Richard J. Holwell agreed that, with a few exceptions, a Plaintiff’s “right is violated when the agency fails to carry the hearing through all steps necessary to completion within ninety days of the request for the hearing.” The Special Litigation Unit brought this case with Ben Taylor of NYLAG’s General Legal Services Unit, and with the law firm of SNR Denton, working pro bono.