Class-action filed re NC Medicaid changes

This graphic is an outline of the State of Noth Carolina with a portion of their state flag inside.
North Carolina

Henry Pashby, 53, needs assistance with bathing and dressing as a result of the loss of the use of his left leg following two strokes. Each week, he receives 33 hours a week of Medicaid-funded in-home assistance, which allows him to live in his home, as opposed to in an institutional setting.

In May 2011, Pashby, who also has multiple sclerosis and carpal tunnel syndrome, received a letter from the Carolina Centers for Medical Excellence informing him he was no longer eligible for in-home services. The letter provided no explanation, except that his “assessed activities of daily living do not meet the minimum (In Home Care for Adults) program requirements …”

On behalf of Pashby and an estimated 3,500 to 4,000 people with disabilities at risk of losing in-home services, Disability Rights North Carolina, the National Health Law Program and Legal Services of Southern Piedmont filed a class-action lawsuit May 31 seeking to block changes to North Carolina’s Medicaid plan for people 21 and over, that went into effect June 1.

Prior to new rules, individuals were eligible for in-home care services if they required hands-on assistance in two of five listed categories: bathing, dressing, toileting, mobility and eating. With the changes, individuals must require either hands-on assistance in three of the categories or extensive assistance or total dependence, the state’s more stringent assistance standards, in two of the categories, according to the lawsuit, filed in the U.S. District Court for the Eastern District of North Carolina.

In contrast, the eligibility standards for assistance in one of the state’s adult homes requires hands-on assistance in just one of seven similar categories. Assistance at the adult homes also does not have to be approved by the federal Department of Health and Human Services and has no hour limitation on services.

“People with disabilities have a legal right to live in the community when that placement can be reasonably accommodated, ” said Vicki Smith, executive director of Disability Rights North Carolina, in a news release. “The State is violating federal law by deciding to pay for a service for people with disabilities living in institutional settings and not pay for the same service for people with disabilities living in the community.”

The lawsuit also charges that the state failed to inform the Centers for Medicare and Medicaid Services of the differences in the eligibility standards when it sought approval for the rule changes. It also alleges that the lack of specific details in the letters informing the individuals about reductions in services violated federal due process rights.

Disability Rights North Carolina is part of the federally funded protection and advocacy system and a member of the National Disability Rights Network.

11 responses to “Class-action filed re NC Medicaid changes

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  4. The Medicaid Waiver, which is being propped up by the Non Disclosure Disagreement created by Piedmont Behavioral Health (PBH), which would allow the LME’s to manage Medicaid, has been deemed to be incongruent with public records law by UNC Chapel Hill Institute of Government. See this blog for more details:
    Marsha V. Hammond, PhD, Licensed Psychologist, Asheville, NC

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