Beneficiaries Sue New York Over Loss of HCBS Services
On July 15, in Taylor v. Zucker, the New York Legal Assistance Group (NYLAG) filed a lawsuit (the Complaint) in the United States District Court for the Southern District of New York on behalf on three plaintiffs for the loss of Medicaid home care services due to the state’s transition to managed care. The Plaintiffs also sought to establish class action status. NAHC’s affiliate, the National Council on Medicaid Home Care, discusses the key elements of the lawsuit below.
The Plaintiffs sued New York for “denying, reducing and terminating Plaintiffs’ Medicaid home care services, by sending inadequate and untimely notices” as well as “failing to provide an opportunity for a fair hearing with ‘aid continuing’” “both of which threaten to result in the unnecessary institutionalization of Plaintiffs.” In New York, “Medicaid home care services” refers to home health, personal care, private duty nursing, and other types of long-term care services. Also, all Plaintiffs lacked “a change in their condition or circumstances that would justify the reduction or termination of their home care.”
As mentioned in the Complaint, in New York, all Medicaid home care services shifted to managed care. Medicaid managed care first came to New York with the approval of a Section 1115 waiver in 1997, called the Partnership Plan. In 2012, CMS expanded the Partnership Plan waiver to require mandatory enrollment in Managed Long-Term Care (MLTC) plans, which are managed care plans for long-term care. This 2012 amendment required beneficiaries dually eligible for Medicare and Medicaid to enroll in MLTC plans to receive Medicaid home care services. For those just receiving Medicaid home care services, Medicaid home care services was included in managed care via mainstream Medicaid managed care plans (MMCs) beginning August 2011.
:: Read Full Article