MANHATTAN (CN) — Condemning the privatization of Medicaid services, three elderly New Yorkers brought a federal class action that says the state has willfully ignored abuses in the long-term care program.
Madeline Bucceri, 93, Patricia Trujillo, 71, and Lourdes Lo, 74, say New York knows that the private, not-for-profit companies with which it has contracted are "systematically failing to provide medically necessary services."
Each claims to have asked for increased home care, only to have their requests either ignored or denied after a lengthy delay. The suit appeared Monday in U.S. District Court for the Southern District of New York.
In addition to New York Health Department Commissioner Howard Zucker, the complaint takes aim at Healthfirst, the private nonprofit manages two MLTCs, short for managed long-term care plans, for the state.
The complaint says the "hands-off manner in which New York is privatizing Medicaid services" is reducing the services that Medicaid recipients need to stay in their homes, and putting their health at risk.
The class says New York knows that the Healthfirst plans are "systematically failing to provide medically necessary services."
Neither the Health Department nor Healthfirst would comment on pending litigation.
There are currently 16,000 New Yorkers receiving services under the program.
Hoping to represent them in this class action are the Legal Aid Society and attorney Jeffrey Kessler with Winston and Strawn.
The 51-page complaint counts more than 100 administrative hearings in which the health department heard testimony regarding the denial of requests for additional home care hours.
In 80 percent of those cases the decision was reversed or the Healthfirst administrator "caved and changed or withdrew their original decisions, effectively acknowledging that their original decisions were wrong," according to the complaint.
Bucceri, Trujillo and Lo say "this persistent level of error was a dead giveaway that the Healthfirst MLTC plans were improperly limiting recipients' home care services."
The Health Department did nothing in response, however, meaning that it either "is failing to oversee and monitor the Healthfirst MLTC plans or it is turning a blind eye to the abuses it sees."
"This heartless and calculating pattern of behavior leaves vulnerable Medicaid recipients at risk of serious injury or institutionalization," the complaint continues.
Lead plaintiff Bucceri says she used to own and operate a salon in Bensonhurst, Brooklyn, before moving to her current apartment on Staten Island. She lives alone, with no family or friends to assist with daily living activities.
Suffering from worsening pain in her hip and leg, Bucceri this summer requested an increase to the 31 hours per week of home care services she receives from her Healthfirst plan, Senior Health Partners.
The defendants didn't increase the services, however, and Bucceri ended up falling while walking to the bathroom.
Once hospitalized, a nurse requested that the plan increase Bucceri's services to 10 hours per day or 70 hours per week. Bucceri was approved for an additional two hours per week, boosting her services to 33 hours per week.
After coming home from the hospital, Bucceri fell again reaching for her walker. Her attorneys requested an expedited hearing for an increase in hours because "increased and uncontrolled pain and urinary frequency."
Senior Health Partners denied the request on Sept. 8.
The complaint says Bucceri sometimes has to put on her pajamas in the afternoon at 1 or 2 because she cannot dress herself once her personal care assistant leaves.
"Without additional home care hours to assist her with basic activities of daily living such as toileting, walking, bathing and dressing, Ms. Bucceri will likely continue to fall, incur unnecessary pain and bodily injuries and suffer emotional harm," the complaint states.
The complaint, which is similar to one filed earlier this year in U.S. District Court for the Eastern District of New York, complains that the Department of Health "unconstitutionally delegated legislative and its rule-making authority over New York's Medicaid Plan to the Healthfirst Enterprise, an amalgam of private parties with a financial interest in reducing how much is spent on home care services for New York's Medicaid recipients who depend on those services so heavily."
It goes onto to say that the health department is looking the other way while the private company "guts the home care services upon which New York's vulnerable Medicaid recipients depend."
The class says Healthfirst must begin accepting, recording and timely processing all requests for increases in home care hours, plus notify recipients in writing of what actions it took.
The Department of Health must acknowledge its due-process role under the Medicaid Act, the complaint says.
In response to the lawsuit, the Health Department would say only that "the Medicaid Program provides home care services to those with complex needs to avoid institutionalization and remain in home."
Healthfirst said it has not yet been served with the lawsuit. "Our primary concern at all times is the health and wellbeing of all our members," the company added in a statement.