Settlement Approved in Medi-Cal Services Cases

(CN) - A federal judge on Wednesday approved amendments to a settlement agreement in cases accusing California of cutting Medi-Cal payments and slashing wages for in-house workers.

The settlement resolves the Oster v. Lightbourne and Dominguez v. Brown lawsuits.

The Oster lawsuit challenged Assembly Bill X4 4, passed in 2009, and Senate Bill 73, passed in 2011, which mandated reductions to the state's In Home Support Services (IHSS) program.

Lead plaintiff David Oster claimed that ABX4 4 violated the Medicaid Act, which requires that states provide sufficient benefits, by terminating or reducing IHSS services to individuals who need them.

Two classes were certified in the Oster lawsuit. The first was for all IHSS recipients whose services would be limited, cut or terminated under the provisions of ABX4 4, and all applicants who would have been eligible for IHSS services but who are either not eligible, or are eligible for fewer services, as a result of the bill.

The second class was for all IHSS recipients who received notices that included a reduction of IHSS hours based on SB 73, including future applicants for IHSS services.

The Dominguez lawsuit, filed by lead plaintiff Lydia Dominguez, challenged wage reductions for IHSS providers, and represents a class of IHSS recipients from 26 counties throughout California.

The settlement calls for a temporary 8 percent across-the-board reduction in authorized service hours instead of a permanent 20 percent cut. The 8 percent cut was to have been implemented starting in July 2013, and was scheduled to be further reduced to 7 percent after 12 months.

The settlement also commits any savings from retroactive federal approval of the new provider fee to be reinvested for the benefit of IHSS recipients.

Under the settlement, recipients have the right to request a reassessment based on a change of circumstances. Recipients will not be required to provide medical certification of a change in their medical condition to obtain a reassessment, which will help ensure that consumers who need additional hours will be able to obtain them.

The amendments to the settlement call for the state to submit proposed legislation authorizing an assessment on home care services by no later than Feb. 1, 2015. If the assessment is passed, the state must then submit a request by April 1, 2015 to the federal Centers for Medicare and Medicaid Services for authorization to implement the assessment.

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