Winter 2013-14 edition of On Target Newsletter now available (.pdf version) (Word version)
Court Orders DHHS to Allow Medicaid Coverage for Workers with Disabilities
November 15, 2013 -- A judge has ordered the North Carolina Department of Health and Human Services to comply with a state law requiring access to Medicaid for workers with disabilities. Disability Rights NC filed suit in June 2013 because DHHS had failed to make Medicaid available to many workers with disabilities as required by the Health Coverage for Workers with Disabilities Act. A preliminary injunction, issued by Superior Court Judge Allen Baddour, now requires DHHS to ensure that the program is available to all who qualify, including the plaintiffs named in the lawsuit. Read the full press release. Get more information about Medicaid Buy-In. Read Judge Baddour's Order for Preliminary Injunction.
Special Edition of Newsletter Available Now - 2014 Targets Presented and Explained
We get a lot of questions about our Targets so we have presented our 2014 Targets in a special edition of our newsletter that answers many of the questions we have received, including:
- What Is a Target?
- What are the 2014 Targets?
- Why Does Disability Rights NC Need Targets?
- Does Disability Rights NC Do Any Work Not Covered by the Targets?
- Who Responded to the 2014 Target Survey?
View and download the special publication on the 2014 Targets here. (PDF version) Check out this page on our website for more information about our Targets.
Settlement with County School System Changes Employment Policy, Creates More Job Opportunities for People with Disabilities
November 1, 2013: The Johnston County Board of Education has modified a policy that prevented people with disabilities from working in the schools. The policy change was prompted by a lawsuit brought by Disability Rights NC on behalf of a former teaching assistant. The policy required all teaching assistants, custodians, and food service workers to be licensed to drive a school bus. Because individuals with certain disabilities cannot meet the requirements to obtain a commercial drivers license, the policy precluded those individuals from working in the Johnston County Schools. The Board entered into a settlement agreement with Patricia Bordonaro, a former teaching assistant who filed a federal lawsuit to challenge the school’s policy and the termination of her employment. Read full press release here.
New Report Addresses Continued Segregation of Workers with Disabilities
October 7, 2013: Disability Rights North Carolina released a new report on segregated employment and the payment of subminimum wages to people with disabilities. Released during Disability Employment Awareness Month, the report titled “Sheltered Workshops and the Subminimum Wage in North Carolina: Incentives and Accountability” proposes practical steps to address the warehousing of people with intellectual and developmental disabilities in settings that lack meaningful work opportunities. Read full report here.
Federal Judge Orders Moses Cone Hospital to Turn Over Peer Review Documents to Disability Rights NC
September 11, 2013: Today, Judge William Osteen in the U.S. District Court, Middle District of North Carolina, issued an order requiring Moses Cone Hospital to turn over peer review documents to Disability Rights NC. The order arises out of a complaint filed by Disability Rights NC in 2011 when the hospital refused to release peer review documents in response to an investigative inquiry made by Disability Rights NC in the course of its investigation of the death of a patient with mental illness. Full press release. Read Judge Osteen's Order and Judgment here.
State Fails to Properly Implement Medicaid Buy-In
Under the Health Coverage for Workers with Disabilities law, an individual who is between the ages of 16 and 65, has a disability, and is working may be eligible for Medicaid benefits. Certain fees and premiums may be charged on a sliding scale based on income, but there is no income limit.
It is estimated that hundreds of individuals who could be qualified for the buy-in are being excluded from coverage. These exclusions are due to improper eligibility determinations and not the availability of funding. If you believe you have been wrongly denied Medicaid under this law, please contact our office. For detailed information about Medicaid Buy-In and your rights, click here to read the fact sheet prepared by Disability Rights NC.
UPDATE - 9/5/2013 - DHHS issued an Administrative Letter that will pave the way for more individuals with disabilities to return to work. The letter partially rectifies DHHS’s failure to comply with the state law requiring access to Medicaid for workers with disabilities. Read more here.
New Guidance for Parent Providers
June 24, 2013 - We recently received a number of inquiries about the application process and denial of parents or legal guardians providing services (“parent-providers”) for adult children on the Innovations waiver by several different Managed Care Organizations (MCOs). We cannot provide legal representation or individualized legal advice on this issue, but we created a packet of information for providers and parents about how they can address denials or other problems with this issue.
Appeals Court Finds DHHS Responsible for Medicaid Contractor's Compliance with the Law
May 10, 2013, Richmond, VA – The Fourth Circuit Court of Appeals dismissed a challenge to a lower court ruling in a Medicaid class-action suit against North Carolina, finding that the defendant, a Medicaid managed care plan, could not maintain its appeal without the state’s involvement. Last year, a federal District Court ordered North Carolina to halt reductions to home and community-based services and restore lost services until the state’s Medicaid agency and its managed care contractor, PBH Healthcare (now doing business as Cardinal Innovations Healthcare), provided beneficiaries with adequate notices and opportunities for impartial hearings when their services were denied, reduced or terminated. Members of the plaintiff class—children and adults with severe developmental disabilities—were threatened with deteriorating health, financial strain and forced to go to institutions to get care.
The Fourth Circuit dismissed PBH’s challenge to a lower court ruling finding that because PBH alone appealed, the court could not disturb the lower court’s order. The court held that as an agent of the state, PBH had no authority to challenge North Carolina’s decision not to join the appeal. Read Court's Opinion.
“Today’s decision is important because it tells state governments that they cannot simply hand Medicaid programs over to private contractors and then walk away, leaving beneficiaries without crucial, mandatory legal protections,” said National Health Law Program Legal Director Jane Perkins. Doug Sea, an attorney at Legal Services of Southern Piedmont added: “Because of this decision, scores of our most vulnerable citizens who desperately need the services that were illegally taken away from them will continue to benefit from the lower court ruling and will receive due process.”
“Once again, the courts have confirmed that state Medicaid agencies must assure that their agents do not deny due process,” said Disability Rights North Carolina Litigation Director John Rittelmeyer. Read the entire Press Release.
Court Orders Reinstatement of Personal Care Services to Pashby Class Members
May 6, 2013 -- After a hearing in the district court on May 1, 2013, Judge Boyle issued an order clarifying the scope of the injunction in Pashby v. Wos. The court ordered the State to reinstate personal care services to all class members whose services were terminated on June 1, 2011. Additionally, the court ordered that, prior to the application of the new personal care policy, the State would have to perform a reassessment of each class member and afford appeal rights and maintenance of services to any class member terminated under the policy.
If you believe are a Pashby class member and have questions, contact either Jennifer Bills or Elizabeth Edwards in our office at 877-235-4210.
Read more about this case and get copies of the judicial decisions here.
Have You Lost Eligibility for Medicaid Reimbursement of Your Personal Care Services?
The State Division of Medical Assistance estimates that between 10,000 and 12,000 people will lose eligibility for Medicaid reimbursement of personal care services as a result of a change in state law. About 1,000 of the people at risk live in group homes with the remainder in adult care homes and family care homes.
If you received a letter that says the Medicaid-funded service or equipment you asked for is denied, terminated, suspended, or reduced, you have the right to appeal within a specific amount of time. Check out the fact sheets on our Resources page for guidance on how to appeal a Medicaid determination.