A New York federal court has ruled against reducing care for Medicaid beneficiaries receiving services at home, following a suit filed in January 2011 by the U.S. attorney’s office in Manhattan that accused the city of vastly overbilling Medicaid for a home care policy authorizing around-the-clock care for people who allegedly didn’t qualify for it, reports the New York Times.
The judge, Shira A. Scheindlin, issued a preliminary injunction ordering the city to stop reducing or terminating so-called split-shift care for certain reasons, except when a physician had personally examined the patient and found a change in medical condition or if the city submitted a declaration that a mistake had been made.
The judge wrote that there was strong evidence that care had been reduced or terminated in many cases without proper notice to patients and because of confusing and contradictory interpretations of state rules for Medicaid, the government health care program for the poor. The city and state can appeal the ruling, reach a settlement with the plaintiffs or continue to fight the suit.
The city’s Human Resources Administration, which administers the Medicaid personal-care program, issued a statement on Wednesday saying, “While we respectfully disagree with some of the court’s finding, we will, of course, comply with the court’s order.” The State Health Department said it was reviewing the decision.
In her ruling, Judge Scheindlin suggested that budget pressures had pushed the city and state to try to cut costs of Medicaid by cutting down on personal care, a major factor in rising Medicaid costs in New York and across the country. But she said officials would be misguided if they were trying to cut those costs by administrative fiat rather than by changes in the law. “Indeed, reforming our health care system has been a dominant topic of the nation’s political discourse in recent years,” the judge wrote.
The ruling follows a class-action lawsuit challenging the reductions handed down by New York for what’s called “split-shift” care, which can cost up to $150,000 per patient each year, says the article, but enables many to remain in their homes instead of transitioning to a nursing home.
Read the full piece at the New York Times.
Written by Alyssa Gerace