Updated OCTOBER 17, 2017
Medicare Counseling & Advocacy
HICAP offers free, comprehensive information and advice about Medicare. Volunteers in every county help callers understand their rights and options for handling problems with Medicare.
Statewide resource for self-help legal information -- Family, Consumer, Disability, Immigration, and more. . .
Legal Aid Association of California (LAAC)
Works with the California courts, the State Bar of California, and legal aid nonprofits to coordinate critical legal assistance to low-income Californians and ensure equal access to justice for all Californians.
Mexican American Legal Defense and Educational Fund (MALDEF) v California Department of Health Care Services
Are Medicaid’s Payment Rates So Low They’re Discriminatory?
SEP 22, 2017 | The PEW Charitable Trusts BLOG by Rebecca Beitsch
Civil rights lawyers suing the state of California over low Medicaid payments say advocates elsewhere should pay attention to a potentially novel legal tactic — accusing the Golden State of racial discrimination in order to increase funding — but some health law experts and even sympathetic observers say they’re watching with some skepticism.
A group of five individual Medicaid beneficiaries in July sued the state of California, arguing that the program’s health services for the poor are so bad that they amount to discrimination against the largely Hispanic population that relies on the program. The state has among the lowest doctor reimbursement rates in the country — only New Jersey and Rhode Island are lower, according to an Urban Institute study — and many California doctors don’t accept Medicaid patients. The result, the plaintiffs say, is long waits or far travels to receive health care.
In California, 48 percent of beneficiaries of Medi-Cal, the state’s Medicaid program, are Hispanic, compared with 20 percent who are white — the second-largest racial demographic of the program, according to the California Department of Health Care Services.
The lawsuit, filed by the Mexican American Legal Defense and Educational Fund (MALDEF) in Alameda County Superior Court, comes at a time when it has become tougher to sue Medicaid. In 2015 the U.S. Supreme Court blocked providers from suing specifically under an equal access provision of the federal Medicaid law, saying enforcement is up to the federal government. READ MORE
Kelley v Kent
CALIFORNIA LAWSUIT HELPS SPOUSES CARE FOR LOVED ONES AT HOME
AUG 10, 2017 | Justice in Aging
Pat Kelley, a 67-year-old veteran and former Los Angeles radio announcer, needs 24-hour care as a result of primary progressive multiple sclerosis. He desperately wants to remain at home, but he and his wife have exhausted almost all of their savings paying for supplementary in-home care. They were facing a draconian choice: either impoverish themselves or move Pat into a nursing home, where Medicaid would help pay for his care. But they shouldn’t have had to.
Since 2014, a federal law has required the spouse of someone who needs Medicaid-funded in-home care to keep some additional income and assets so that they can pay the rent, buy food, and meet their other needs, while their spouse qualifies for Medicaid. This law was intended to help people like Mr. Kelley avoid unnecessary institutionalization. But California failed to implement the law.
On July 7, 2017, working with partners, we filed a lawsuit against the state of California to compel the state to implement the law.
Already, as a result of the lawsuit, on July 19, California’s Department of Health Care Services instructed counties to apply spousal impoverishment provisions to married individuals who apply for Home and Community-Based Services (HCBS). We’ll keep you updated as the case progresses. READ MORE ABOUT THE CASE
Alexander v. Price
Hospital "Observation Status"
CLASS CERTIFIED FOR MEDICARE PATIENTS IN "OBSERVATION STATUS" CASE
AUG 8, 2017 | Justice in Aging
Nancy Niemi was hospitalized for 39 days after a visit to an emergency room. She’s 84-years-old and eligible for Medicare. The hospital, however, categorized her as an outpatient receiving “observation services” for her entire stay. Medicare covers hospital care through an inclusive payment under Part A if the stay is classified as inpatient, but patients may incur unexpected cost sharing if the stay is classified as “outpatient” observation covered under Part B. Ms. Niemi was now in debt for thousands of dollars for her entire 39-day stay, and, in addition, Medicare does not permit beneficiaries to appeal when they are classified as receiving observation services when they are in the hospital, so she had no way to challenge the lack of coverage.
Due to a federal court decision issued last week, Nancy Neimi is now a member of a nationwide class of hospital patients who may gain the right to appeal their placement on observation. Hospitals commonly classify patients under observation, and, until March of this year, often without their knowledge. This practice has left many older adults and others with thousands of dollars in surprise bills not just for the hospital stay, but also medicine and other services received while classified as under observation. Class members could number in the hundreds of thousands. One study found that, in 2009 alone, 918,180 Medicare beneficiaries experienced observation stays.
Justice in Aging filed the original lawsuit (now named Alexander v. Price) along with the Center for Medicare Advocacy in 2011. The case was initially dismissed, but plaintiffs appealed to the 2nd Circuit and prevailed. The case is now going forward on the Due Process claim. Specifically, the plaintiffs allege that Medicare must allow beneficiaries to challenge the decision they are only receiving observation services. The class certification order was issued on July 31, 2017 and can be read here.
If you have a client who you think may be a member of the class, you can submit their story here. Otherwise, no action is required at this time. We’ll keep you updated on the case as it moves forward.
Medicaid Reimbursement Rates
EFFORTS TO INCREASE MEDI-CAL RATES CONTINUE, DESPITE SCOTUS RULING
APR 2, 2015 | California Healthline
Key Words: Medi-Cal reimbursement rates | access to care | Medi-Cal managed-care plans | AB 366 | SB 243
ARMSTRONG V. EXCEPTIONAL CHILD CENTER BAD FOR POOR SENIORS
MAR 31, 2015 | Justice in Aging | Justice in Aging Health Network Alert
If you believe that poor seniors should have at least the same access to justice through the courts as telecom companies, oil giants, automakers, and the tobacco industry, you should be very disappointed in yesterday’s Supreme Court decision in Armstrong v. Exceptional Child Center. The decision rejected Idaho health care providers’ attempt to enforce a provision of the Medicaid Act that requires states to ensure that doctors and other Medicaid-participating providers are adequately paid.
SCOTUS: PROVIDERS CANNOT SUE OVER LOW MEDICAID REIMBURSEMENTS
MAR 31, 2015 | California Healthline
Key Words: health care providers | Medicaid agencies | low reimbursement rates | access to care | supremacy clause
BREAKING: PROVIDERS CAN'T SUE STATE MEDICAID AGENCIES OVER RATES, SUPREME COURT RULES
MAR 31, 2015 | Modern Healthcare
Key Words: healthcare providers | state Medicaid agencies | low reimbursement rates | supremacy clause | access to care
In Home Supportive Services (IHSS)
FEDERAL JUDGE ORDERS DELAY OF ENTIRE NEW FEDERAL OVERTIME REGULATIONS FOR HOME CARE WORKERS UNTIL JAN 15 HEARING IN WASHINGTON, DC
California will suspend implementation of IHSS overtime until that date
DEC 31, 2014 | CDCAN Report December 31, 2014
LAWSUIT SLAMS THE STATE'S DUALS PROJECT
JUL 7, 2014 | California Heathline
Stakeholders filed a lawsuit in Superior Court lambasting Cal MediConnect, the dual eligibles demonstration project that is part of the state's Coordinated Care Initiative.
Darling v Douglas
IN MEMORY OF
Ester Darling, lead plaintiff in the Darling v Douglas lawsuit of 2011, shown here signing the Darling v Douglas legal settlement, died peacefully in her sleep July 18, 2017, at age 80, in Woodland, CA.
Esther faced many challenges during her life but none were as life changing as the stroke she suffered in 1996. With her left side paralyzed, this once independent woman found herself unable to manage her own care.
Determined to be discharged from the post-acute nursing home despite no family to depend on, she was referred to Yolo Adult Day Health Center.
There, with additional support from In-Home Supportive Services, Esther was able to move back to her apartment. At the ADHC center she continued her therapies, received timely nursing and social work support and thrived in the company of fellow participants.
Early in 2011, during an emergency budget session of the Legislature, adult day health care was eliminated as an optional Medi-Cal benefit. Esther and 35,000 other low-income Californians feared the worst. When she was approached by Disability Rights California to serve as a plaintiff for the class action suit being filed, Esther, along with seven other plaintiffs, was more than willing to share her personal story in hopes of saving her center and the 300 other centers throughout the State.
As the ADHC case made its way through federal court, first one and then a second lead plaintiff passed away. Esther agreed to become the lead plaintiff. The case was settled in December 2011 and Esther beamed with pride as she signed the settlement agreement that meant adult day health care was saved as a Medi-Cal benefit for her and tens of thousands of others like her.
Rarely does a poor small town girl from Oklahoma get a chance to truly shape the lives of many thousands for many years to come. Esther Darling's name will forever be memorialized in the settlement and she will lovingly be remembered for her role in saving ADHC for future generations. She is resting in peace at Monument Hill in Woodland, California.
ADHC Medi-Cal Beneficiaries Transfer to CBAS Program
FEDERAL COURT JUDGE APPROVES DARLING v. DOUGLAS SETTLEMENT
JAN 24, 2012 | Settlement Agreement Summary (11/17/2011; 6 pages) | Settlement Addendum (Filed 4/3/2012; 7 pages) | Settlement Agreement (12/1/2011; 55 pages)
On January 24, 2012 Judge Saundra Brown Armstrong gave final approval to a settlement in the case of Darling v. Douglas. The settlement agreement between the seven plaintiffs who represent a class of 35,000 Adult Day Health Care (ADHC) patients throughout California and the California Department of Health Care Services will transition Medi-Cal patients out of ADHC and into a new Community-Based Adult Services (CBAS) program offered through Medi-Cal managed care plans on or after July 1, 2012. CBAS will offer center-based skilled health and nursing care, therapies, transportation and other services to eligible low income seniors and persons with disabilities.
COURT ORDER GRANTS PRELIMINARY APPROVAL OF DARLING v. DOUGLAS SETTLEMENT
DEC 14, 2011 | Court Order (12/14/2011; 70 pages)
On December 14, the United States District Court for the Northern District of California issued an order granting preliminary approval of the Darling v. Douglas settlement agreement, directing notice to the class, and setting a scheduling order and fairness hearing. Before final approval may be granted by the court, members of the class are to be notified and afforded an opportunity to object in writing, and/or appear at the Fairness Hearing which will take place on January 24, 2012.
A copy of the notice to class members, in English and appropriate threshold translations, has been posted on the DHCS website at: http://www.dhcs.ca.gov/services/medi-cal/Pages/ADHCClassActionSettlement.aspx.
DHCS will mail the notice in English to all class members. Soon thereafter, notices in threshold languages will be mailed to participants and also posted to the DHCS website. Additionally, DHCS will fax copies of the class notice to all Adult Day Health Care Centers with instructions to post the notice in their centers.
SERVICES TO CONTINUE FOR ADHC PATIENTS AND FAMILIES, FEDERAL COURT SETTLEMENT REACHED IN DARLING v. DOUGLAS CASE
NOV 17, 2011 | CAADS Media Statement (11/17/2011) | DRC Press Release (11/17/2011) | CA DHCS Press Release (11/17/2011)
Sacramento -- “Immense relief” and “joy” are the words that California Association for Adult Day Services Executive Director Lydia Missaelides uses to describe the sentiments of tens of thousands of elder, chronically ill and disabled patients after a major settlement was reached today in a lawsuit against the state brought on their behalf by Disabilities Rights California.
PEOPLE WITH DISABILITIES SUE TO HALT ELIMINATION OF ADULT DAY HEALTH CARE
JUN 9, 2011 (courtesy of Disability Rights California)
Oakland, CA -- Today, seven plaintiffs filed a motion for a preliminary injunction in a class action lawsuit on behalf of 35,000 low-income people with disabilities, including older adults. Filed in federal court, the case is called Darling et al. v Douglas, et al. C:09-03798 SBA.
Plaintiffs seek to stop the state from eliminating Adult Day Health Care (ADHC) as a Medi-Cal benefit, as of September 1, 2011 without ensuring that affected people are not harmed, including by being hospitalized or placed in nursing homes.
OBAMA ADMINISTRATION OPPOSES CHALLENGES TO MEDICAID CUTS
MAY 28, 2011 | New York Times Article by Robert Pear (5/28/2011)
Washington -- Medicaid recipients and health care providers cannot sue state officials to challenge cuts in Medicaid payments, even if such cuts compromise access to health care for poor people, the Obama administration has told the Supreme Court.
U.S. DEPT OF JUSTICE FILES "FRIEND OF THE COURT" BRIEF SUPPORTING DRC LAWSUIT COTA (BRANTLEY) v. DAVID MAXWELL-JOLLY -- THE 2010 ADHC MEDICAL NECESSITY CRITERIA CASE
JUN 28, 2010 | U.S. DOJ Amicus Brief (6/28/2010; 38 pages)
PRELIMINARY INJUNCTION ORDERED BY FEDERAL COURT IN BRANTLEY v. DAVID MAXWELL-JOLLY STOPS NEW ADHC MEDICAL NECESSITY CRITERIA FROM TAKING EFFECT
FEB 24, 2010 | Order Granting Plaintiffs' Motion for Preliminary Injunction (2/24/2010; 26 pages)
On February 24, 2010, a federal court stopped new ADHC medical necessity criteria from taking effect March 1, 2010 as approved in the 2009-10 state budget trailer bill (AB4X 5). The state was also ordered to provide notice to ADHC Medi-Cal beneficiaries.
On August 18, 2009, Disability Rights California challenged in federal court the Medi-Cal budget cuts to the Adult Day Health Care program that temporarily limited beneficiaries to no more than three days per week attendance, leaving no alternatives for many older Californians with serious disabilities who needed care four or five days per week (Brantley v. Maxwell Jolly). The judge granted the motion for preliminary injunction on September 10, 2009.
On December 18, 2009 an amended legal brief was filed by Disability Rights California, and on January 19, 2010 a motion for preliminary injunction was filed challenging the legality of new ADHC eligibility and medical necessity criteria.
FEDERAL ACTION ON CALIFORNIA DHCS STATE PLAN AMENDMENT, ACTION ON 2008 PROVIDER RATE CUT
NOV 18, 2010 | Action on 2008 Provider Rate Cut (11/18/2010; 2 pages)
California Association for Adult Day Services
1107 9th Street, Suite 701 || Sacramento, CA 95814-3610
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