California Plaintiffs Win Case Against State for Failing to Provide Federally-Mandated In-Home Supportive Services

By | CA Health Network Alert, In-Home Supportive Services, PRESS RELEASE

State must reimburse or pay Medi-Cal recipients and conduct statewide outreach to thousands of Californians who may be eligible for in-home services

LOS ANGELES — Thousands of Medi-Cal beneficiaries with significant disabilities will now be able to access affordable Medi-Cal care at home, rather than going to a nursing facility. In-home care provides greater stability and health outcomes for individuals and families, and it is cost-effective for the state; but it can be prohibitively costly to pay for out-of-pocket. As a result, married people with disabilities often have to make a draconian choice: impoverish themselves and their spouses or go to a nursing facility.

“My wife and I live primarily on a fixed income of pensions and social security; we exhausted our life savings and retirement accounts paying for my care,” said plaintiff Patrick Kelley, a 68-year-old U.S. Army veteran living with spastic quadriparesis. “My wife’s ability to work was severely limited by her caregiving responsibilities to me. We spent almost all of her limited income paying for my in-home care.”

Thanks to the successful lawsuit against the state, married people with disabilities will now learn about their right to Medi-Cal eligibility so they can stay at home with their spouse, receive care, and be reimbursed through the state’s Medi-Cal program for In-Home Supportive Services (IHSS). The court ruling makes it clear that the state must fully implement a federal law, known as the expanded spousal impoverishment protection, which should have been implemented as part of the Affordable Care Act in 2014.

“This ruling will dramatically improve the quality of life for disabled Californians and their family caregivers and will prevent many Californians from falling into poverty due to the high cost of in-home care,” said Kim Selfon, IHSS Client Advocate at Bet Tzedek. “Caregivers selflessly care for their disabled spouses with courage and compassion, often to the detriment of their own finances and health. They and thousands of others will now have the support they need to continue caring for their loved ones at home.”

The two plaintiffs’ situations illustrate the diversity of the thousands of individuals that will be impacted by the outcome of this case.

“The judge’s decision is a boost to Welfare and Institutions Code section 10500, which says agencies must secure for every person the aid to which they are entitled. As California’s population ages, in-home care will become increasingly important to the future of the state,” said attorney Cori Racela of Western Center on Law & Poverty.

Plaintiff Matthew Reed is a 63-year-old man with multiple sclerosis, Bell’s Palsy, and vascular dementia from a stroke. Due to the severity of his disabilities and medical condition, Mr. Reed is eligible for Medi-Cal home services, and should have had access to care without out-of-pocket costs under spousal impoverishment protections. Instead, he was required to pay more than $1,500 per month for care, which he cannot afford.

“If the spousal impoverishment rule had been implemented as it should have, Matthew could have been found eligible for free Medi-Cal and IHSS,” said Matthew Reed’s wife, Vicki Reed. “That means my son or I could have earned IHSS wages, sparing us incalculable stress and anxiety and giving us better options for Matthew’s home care and more financial resources. I don’t want any other families to go through what we have gone through.”

The Affordable Care Act set a deadline to expand spousal impoverishment protections to home-based care starting January 1, 2014. However, the Department of Health Care Services (DHCS) failed to issue any guidance about the rule until July 2017, after Mr. Kelley and Mr. Reed brought this lawsuit.

The ruling in Patrick Kelley & Matthew Reed v. California Department of Health Care Services, et. al., was issued by a Los Angeles Superior Court judge on January 14, 2020. It concludes that DHCS must a) notify beneficiaries who could benefit from the rule, particularly those denied or discontinued from Medi-Cal because DHCS failed to implement the rule on time; b) create a process for people to be found eligible for IHSS retroactively to the date they applied for Medi-Cal; and c) allow impacted individuals to be paid for home services they were entitled to during the delay period.

“Choosing between remaining at home without needed services, impoverishing oneself and one’s spouse, or moving into a facility separate from loved ones is no choice at all,” said Claire Ramsey, Senior Staff Attorney at Justice in Aging. “This ruling means relief for many who have struggled to stay at home and in their community and receive the services they need.”

Bet Tzedek is committed to providing free legal services to those that need them most. Bet Tzedek attorneys and advocates help people of all communities and generations secure life’s necessities. Wherever people are in crisis, Bet Tzedek’s core services and rapid response programs provide stability and hope. Founded in 1974, Bet Tzedek – Los Angeles’ House of Justice – helps over 50,000 people each year.

Justice in Aging is a national organization that uses the power of law to fight senior poverty by securing access to affordable health care, economic security, and the courts for older adults with limited resources. Since 1972 we’ve focused our efforts primarily on fighting for people who have been marginalized and excluded from justice, such as women, people of color, LGBTQ individuals and people with limited English proficiency.

Disability Rights California (DRC) is the agency designated under federal law to protect and advocate for the rights of Californians with disabilities. The mission of DRC is to advance the rights, dignity, equal opportunities, and choices for all people with disabilities.

Western Center on Law & Poverty fights for justice and system-wide change to secure housing, health care, racial justice and a strong safety net for low-income Californians. Western Center attains real-world, policy solutions for clients through litigation, legislative and policy advocacy, and technical assistance and legal support for the state’s legal aid programs. Western Center is California’s oldest and largest legal services support center.

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Contact: Vanessa Barrington
510-256-1200 direct
vbarrington@justiceinaging.org

Justice in Aging Joins Amicus Brief Urging the Supreme Court to Defend the ACA

By | Health Care, Medicaid, Medicare, PRESS RELEASE

On January 15, Justice in Aging joined AARP and the Center for Medicare Advocacy in submitting an amicus brief urging the U.S. Supreme Court to expedite its review of a case challenging the constitutionality of the Affordable Care Act (ACA). The brief argues that the uncertainty caused by the Fifth Circuit’s decision to remand the case to the district court is harming older adults and that declaring the entire ACA unconstitutional will cause millions of older adults to lose health insurance coverage and vital consumer protections.

Several states led by Texas, along with the U.S. Department of Justice, are asking the courts to declare the entire ACA unconstitutional because Congress zeroed out the tax penalty for not complying with the law’s individual mandate to have health insurance. A federal district judge agreed and issued a ruling that the entire ACA is unconstitutional in December 2018. On appeal, the Fifth Circuit decided that the individual mandate without a penalty is unconstitutional, but remanded the decision back to the district court to review the ACA provision-by-provision to determine whether each is viable without the mandate.

Our amicus brief, filed in support of the states and the U.S. House of Representatives who are defending the ACA, demonstrates how the ACA’s critical protections and coverage expansions have improved the health and well-being of older adults, and how invalidating the ACA would disrupt the entire health care system, undermine the Medicare and Medicaid programs, and harm low-income seniors and their families. As explained in our statement on the Fifth Circuit’s decision and in our issue brief on the importance of the ACA to low-income older adults, millions of older adults and people with disabilities are alive and healthier today because the ACA enabled access to health care they couldn’t otherwise obtain.

Because of the ACA:

  • The lives of over 19,200 older adults on expanded Medicaid have been saved.
  • Seniors and people with disabilities have more opportunities to age in place and live at home, in their communities, where they want to be.
  • There is more care coordination for individuals who are dually eligible for Medicare and Medicaid and better protections for the lowest-income seniors from illegal billing for Medicare cost-sharing.
  • Seniors have stronger protections from discrimination and a new avenue for enforcing their civil rights.
  • Medicare beneficiaries have better access to preventive services and prescription drug coverage.

If the Supreme Court is persuaded by our arguments and upholds the constitutionality of the ACA, 100 million Americans with pre-existing conditions and 13 million Americans enrolled in expanded Medicaid will be able to move on with their lives without fear of losing coverage. And we can continue to build on the progress we have made using the ACA’s tools to enhance care coordination and consumer protections for Medicare and Medicaid beneficiaries, end discrimination, and eliminate health disparities, and achieve Justice in Aging for all.

Executive Director Kevin Prindiville’s Statement on ACA Ruling

By | PRESS RELEASE

Below is a statement from Justice in Aging’s Executive Director Kevin Prindiville on yesterday’s ruling on the Affordable Care Act by the 5th Circuit Court of Appeals.

Yesterday, the 5th U.S. Circuit Court of Appeals ruled that the Affordable Care Act’s individual mandate is unconstitutional, and remanded the case to the District court to clarify whether the rest of the ACA can stand without the mandate. For now, the ACA remains in place without the mandate, but, if the law is invalidated, the health of millions of older Americans and their families is at risk.

The ACA is a lifeline for older adults and people with disabilities. If the ACA is ultimately found unconstitutional, 100 million Americans with pre-existing conditions and the 20 million people who gained coverage through Medicaid expansion would face higher health care costs or lose access to coverage entirely. Populations of color who saw the greatest coverage gains under the ACA would be particularly harmed.

District Court Judge Reed O’Connor, who previously ruled that the entire ACA should be struck down, is unlikely to make a different decision a second time. Rather, today’s decision only serves as a delay, causing uncertainty, fear, and disruption in the current health insurance market and in the lives of older adults, their families, and all Americans.

Justice in Aging Files Amicus Brief Arguing that the Department of Homeland Security’s Final Public Charge Rule Illegally Targets Older Adults and Their Families

By | PRESS RELEASE
Oakland, Ca—Last week, Justice in Aging and partner organizations filed an amicus brief in six separate lawsuits in three United States District Courts challenging the Department of Homeland Security’s recently finalized “public charge” rule arguing that it unlawfully targets older immigrants and their families. The rule essentially bars low-income older adults from entering the country or obtaining lawful permanent residency status (greencard). Read More

Beneficiary Advocates Raise Alarms Concerning Roll-Out of New Medicare Plan Finder and Revision of Medicare Marketing Rules

By | News Releases, Newsroom, PRESS RELEASE
Washington, DC ─ Justice in Aging, Medicare Rights Center, Center for Medicare Advocacy, and the National Council on Aging sent a joint letter to Seema Verma, Administrator of the Centers for Medicare & Medicaid Services (CMS), on August 27, 2019, urging the agency to address concerns regarding changes to the Medicare Plan Finder (MPF) tool and the 2020 Medicare Communications and Marketing Guidance (MCMG).

The four organizations expressed appreciation for CMS’s efforts to update these resources to better support beneficiary decision-making, while raising concerns that the revisions may instead have the opposite effect. The groups urged CMS to mitigate adverse consequences by closely monitoring the roll out and functionality of the new MPF tool, providing enrollment relief as needed, and by rescinding the updated MCMG in its entirety. Read More

Court Denies All Government Motions in Class Action Seeking Appeal Right for Medicare Beneficiaries on “Observation Status”

By | News Releases, Newsroom, PRESS RELEASE
In a decision issued on March 27, 2019, a federal judge denied multiple attempts by the federal government to halt a lawsuit by Medicare patients seeking a right to appeal their placement on “outpatient observation status” in hospitals. Alexander v. Azar is a nationwide class action brought by individuals who were forced to pay up to $30,000 for post-hospital skilled nursing facility care because they had been classified as outpatients in observation status, rather than as inpatients. Read More

Advocacy Groups Sue State of Florida for Violating the Americans with Disabilities Act

By | News Releases, Newsroom

A class action lawsuit filed today against Florida’s Agency for Health Care Administration asserts that the state’s management of its Medicaid long-term care system violates Title II of the Americans with Disabilities Act. By perpetuating the institutionalization and segregation of older adults and people with disabilities and severely limiting their access to community-based services, the state forces people to unnecessarily enter nursing facilities to get care.

Justice in Aging, a national non-profit legal advocacy organization that fights senior poverty, and Southern Legal Counsel, a Gainesville, Florida-based, statewide nonprofit law firm, filed the suit on behalf of their clients, who are on the state’s waiting list for home-based long-term-care services and are currently at risk of unnecessary and unwanted institutionalization. Disability Rights Florida, private attorney Nancy Wright, and lawyers from the firm of Cozen O’Connor are co-counsel. Read More

AARP’s Asian American Pacific Islander Community Honors Denny Chan with its 2018 Hero Award

By | Health Care Defense, PRESS RELEASE, Safety Net Defense, SENIOR POVERTY
Oakland, CA (August 20, 2018) –Justice in Aging is proud to announce that the Asian American and Pacific Islander Community of AARP has honored Justice in Aging attorney Denny Chan with its annual Hero Award.

Every year, for the past three years, the AARP AAPI Hero Awards have recognized volunteers and non-profit organization staff members who work tirelessly behind the scenes serving Asian Americans and Pacific Islanders over 50 years of age. The award was announced on Facebook on August 16. You can watch the winning video about Denny’s good work on behalf of low-income older adults. Read More