Suit Alleges NY Department of Health Fails to Protect Rights of Managed Long-term Care Enrollees
The New York Legal Assistance Group has filed suit in federal court for the Eastern District of New York on behalf of disabled recipients of Medicaid-funded long-term home care services, challenging the failure of the New York State Department of Health (DOH) to protect them from reductions and terminations of their care without due process of law.
Individuals who receive home care have disabilities and diseases that make them unable to live in their homes without assistance. Since 2012, DOH requires most Medicaid recipients in New York State to enroll in Managed Long Term Care Plans (MLTCPs) in order to obtain home care services.
DOH contracts with MLTCPs, which are private entities, to provide Medicaid recipients with various services, including home care. But, DOH has failed to create a transition plan to protect MLTCP enrollees if their plans choose to close or pull out of a specific region or county.
“As a result of DOH’s failure to ensure that GuildNet’s enrollees continue to receive the level of care they were receiving, these vulnerable people are at risk of inappropriate and unnecessary institutionalization, and are now plunged into stressful uncertainty about their futures as they struggle to find new plans to provide their care,” said Jane Greengold Stevens, NYLAG’s Director of Special Litigation.
In March, GuildNet sent a letter to all enrollees in Suffolk, Nassau, and Westchester Counties — over 4,000 people — announcing that it would terminate services in those counties on June 1. The letter also stated that enrollees would have to find new plans if they wanted to continue receiving home care.
GuildNet did not inform enrollees that they have a right to keep the same level of care, whether from GuildNet or a new plan, until and unless they have an opportunity for a Fair Hearing at which to challenge any reduction. Since receiving the letter, many GuildNet enrollees have been unable to find a new plan that will accept them at their current level of care—with many plans offering them far fewer hours of home care than are necessary to keep them safely at home.
Only when advocates complained to DOH and threatened to take legal action did DOH notify enrollees that the State requires GuildNet to continue providing home care services past June 1 and until enrollees can transition to a new plan. However, DOH did not assure enrollees that they would be able to keep the same level of services, whether from GuildNet or a new plan, until and unless they had an opportunity to challenge any proposed reduction a Fair Hearing.
The class action alleges that DOH is violating the rights of GuildNet enrollees under the Medicaid Act, the Americans with Disabilities Act, Section 504 of the Rehabilitation Act, and the Due Process Clause of the Fourteenth Amendment to the U.S. Constitution.