NY: Report Shows That Insurers Wrongfully Cutting Home-Care Hours for Vulnerable Adults

A new, detailed report by a coalition of more than 100 nonprofit groups shows that since January 2015, Senior Health Partners and at least two other companies have been systematically cutting the hours of home care for their disabled clients, typically without proper notice or legal justification, the study found. By law, only a change in a client’s medical condition or circumstance is supposed to allow a reduction. The study was co-sponsored by Medicaid Matters, which is an advocate for Medicaid beneficiaries, and by the New York Chapter of the National Academy of Elder Law Attorneys (NAELA). It independently confirms similar allegations made earlier this year in a federal class-action lawsuit filed against and the New York State Health Department on behalf of disabled and aged clients threatened with cuts in home care. Between June 2015 and December 2015, the study found a sixfold increase in hearings that challenged home-care reductions. In more than 90 percent of those 1,042 hearings, the companies lost or simply withdrew proposed cuts when challenged. Though Senior Health Partners is only one of more than 20 such plans in New York, serving about 12 percent of managed long-term care clients, it accounted for 56 percent of those hearings. Not counting settlements, managed care companies prevailed only 1.2 percent of the time.

Source/more: New York Times 

Study on Medicaid Home Care Reductions by Managed LTC Plans

In 2015, elder lawyers and other advocates who represent consumers enrolled in Medicaid Managed Long-Term Care (MLTC) plans in New York observed a sharp increase in the number of clients reporting that their MLTC plans had sought to reduce their home care services. This increase in cases raised concerns about whether these reductions violated the rights of plan members. The New York NAELA Chapter and other advocates undertook this study to examine the prevalence and extent of reductions by MLTC plans, and to assess plan compliance with procedural requirements for reducing hours of care.

Read the full report: Medicaid Matters New York, Mis-Managed Care