NYC Medicaid Lawsuit Spreads Concerns About At-Home Care Services
Health care advocates and disability lawyers have expressed concern that a lawsuit alleging New York City improperly authorized in-home care for Medicaid beneficiaries could have negative repercussions, the New York Times reports (Hartocollis, New York Times, 1/12).
Details of Lawsuit
The lawsuit alleged that New York City overbilled Medicaid by several million dollars after the city improperly approved 24-hour home care for thousands of beneficiaries. According to the suit, the city acted improperly after a 2006 Medicaid rule change relieved the city of having to contribute to the cost of the round-the-clock care. Before the rule change, the cost of 24-hour home care for Medicaid beneficiaries was equally split between the federal government and states.
According to the suit, the city enrolled patients who did not require such care and approved in-home care for individuals who needed more intensive services such as nursing home care, which would have required the city to contribute to the cost.
A federal investigation into the matter found that about 17,500 Medicaid beneficiaries in the city received 24-hour "personal care services" from 2000 to 2010, at a cost of between $75,000 annually for beneficiaries requiring a single aide and $150,000 annually for those needing care from several aides (Hartocollis, New York Times, 1/11).
The lawsuit does not indicate whether Medicaid beneficiaries should receive at-home care. Instead, it alleges that the city overruled physicians who should be the ones to decide. The U.S. attorney's office's lawsuit suggested that the motive for putting people in at-home care with an aide was to shift costs after the 2006 rule change, though city officials have contested that accusation.
The suit taps into a contentious debate over the growth of at-home care, which is one of the largest challenges in state and federal attempts to control Medicaid costs.
However, health care advocates are more concerned that the suit could result in more Medicaid beneficiaries being forced into institutions instead of receiving at-home care. Disability lawyers said the opportunity to stay at home is a civil right protected by antidiscrimination laws (New York Times, 1/12).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.