The lawsuit, filed in United States District Court for the Southern District of New York, names three plaintiffs: an impaired 84-year-old woman living alone in Manhattan, a frail 18-year-old Brooklyn man with severe congenital disabilities, and a 65-year-old Manhattan man with diabetes and a schizoaffective disorder. But it was brought by the New York Legal Assistance Group on behalf of tens of thousands of disabled Medicaid beneficiaries who need home health care or help with daily tasks like bathing and eating.
It represents a challenge to an ambitious Medicaid overhaul by Gov. Andrew M. Cuomo that shifted $6 billion in public spending on long-term services, including home care, to private managed care companies that are paid a fixed sum for each enrollee. The goal of the overhaul, which was set in motion in 2011, was saving money and improving the coordination of care. But advocates for aged and disabled people have complained that in the scramble for the most lucrative enrollees, companies are shunning frail people with the greatest needs and signing up those who could be given minimal services….
Janie Taylor, the lead plaintiff on the case, was required last year, as part of the Medicaid overhaul, to enroll in one of two dozen plans provided by private managed care companies under contract to the state. Before the changes, Ms. Taylor, an octogenarian with diabetes, high blood pressure and a dangerously unsteady gait, had the help of an aide for 10 hours a day, seven days a week. That care was continued at first by her managed care plan, VNSNY Choice. But on July 1, the lawsuit says, without notice or explanation, VNSNY cut her services to five hours a day, though her condition had not changed.