Lawsuit targets “arbitrary” NC Medicaid changes

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News from North Carolina

Disability Rights North Carolina filed a class action lawsuit July 1 against the state of North Carolina and one of its managed care contractors, the same day the contractor began using a new system to determine eligibility for certain Medicaid services.

The lawsuit affects about 675 individuals who previously received services through the Piedmont Behavioral Healthcare Innovations Waiver. The Piedmont Behavioral Health Care’s new waiver program, the Support Needs Matrix, divides people with disabilities in need of community and home based services into four categories: youth and adult, and those living in either homes or residential facilities. The individuals are then scored in one of seven categories, depending on a scale determining the costs of services required to assist with their disabilities.

According to the lawsuit, the state violated federal Medicaid law by creating a system that assesses individuals without consulting their treatment providers and by eliminating services for people with disabilities that were previously categorized as medically necessary.

The lawsuit also contends that the process of switching to the new program violated constitutionally enforced due process rights by not notifying the individual’s of their rights to appeal the scoring decisions or providing explanations for changes to services.

“Defendants have engaged in arbitrary, secret procedures that deny, reduce, and terminate Medicaid services based on vague, inconsistent, subjective criteria that bear little, if any, relation to the degree of service and support needed by individual waiver participants,” according to the lawsuit, filed in the U.S. District Court for the Eastern District of North Carolina.

Piedmont Behavioral Healthcare provides services in five counties across the state. The state Department of Health and Human Services plans to phase in the Support Needs Matrix throughout the state.

Also listed as plaintiffs in the lawsuit are the National Health Law Program and Legal Services of Southern Piedmont.

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