Medicaid Matters and the New York chapter of the National Academy of Elder Law Attorneys released a report analyzing six months of fair hearing
decisions related to reductions in hours for New York home care clients. The
evidence suggests that some managed-care plans are cutting hours without
A recent New York Times article calls attention to a report documenting challenges being faced by people with disabilities served by New York’s Medicaid Managed Long Term Care (MLTC) system. The report, issued by Medicaid Matters and the New York Chapter of the National Academy of Elder Law Attorneys, analyzes six months of fair hearing decisions related to reductions in MLTC enrollees’ home care hours.
The analysis found a pattern of unjustifiable reductions in enrollees’ home care hours, with a few plans accounting for the majority of cases. The New York Times article takes a look at how these reductions in hours—often reversed during the hearings– affect the enrollees and those who care for them. In the example in the article, the enrollees’ hours were cut in half – negatively impacting the enrollee, her family caregivers, and her paid caregiver.
Impact on Quality of Care
A home care client’s quality of care and quality of life often depends on having a consistent, high-quality relationship with one or more home care aides. When service hours are cut without justification, an enrollee is not only prevented from getting the care they need, but the relationship between the aide and the client may be damaged, disrupting a stable situation and creating cascading problems for both the client and the caregiver.
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Impact on Quality of Jobs
For home care aides, reductions in care hours impacts work schedules, livelihoods, and their ability to form and maintain client relationships. In the example provided in the article, the aide – who has a 7-year-old child at home – was switched to working weekends, rather than Monday through Friday, which negatively impacted her finances and her ability to care for her child.
To avoid future unnecessary reductions in care and create a more accountable system, the fair hearing report recommends:
- Increased monitoring of managed-care plans, including collecting and publicly publishing data on reduction of hours;
- The review of previous reductions in care to restore hours for enrollees who were not aware of their rights or unable to go through the fair hearing process; and
- The publication of fair hearing decisions in a manner that is easier to understand and more transparent.
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Medicaid Matters New York (MMNY) is the statewide coalition dedicated to advancing the interests of Medicaid beneficiaries.
National Academy of Elder Law Attorneys, NY Chapter (NY NAELA) – NY NAELA is the local chapter of a national professional association of elder law attorneys in the private and public sectors who are dedicated to improving the quality of legal services provided to people as they age and people with special needs
REPRINT: Original article can be found at phinational.org
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