Big Win for 13 Medicaid Recipients Who Had Lost Access to PCS

Big legal win for 13 Medicaid PCS recipients Tuesday, April 2, 2013!


13 North Carolina Medicaid recipients brought suit against the Department of Health and Human Services (DHHS) when they lost access to in-home PCS due to the General Assembly passing stricter PCS eligibility requirements in 2010.

PCS is a Medicaid service that assists disabled adults with daily tasks such as eating, toileting, and bathing.

The 13 Medicaid recipients argued that the new PCS program violated the Social Security Act, the Americans with Disabilities Act (ADA), and the Rehabilitation Act, among other claims.

The District Court agreed.  Judge Boyle held that the new PCS program treats people with similar needs differently and puts North Carolinians “who have been successfully living in their own homes…at risk of segregation, in the form of institutionalization.”

On March 5, 2013, the 4th Circuit Court of Appeals upheld the District Court’s 2011 decision to stop the State of North Carolina from implementing a 2010 policy concerning Medicaid personal care services (PCS).

For the March 5, 2013,  4th Circuit Court decision in Pashby v. Delia, click here.

After the 4th Circuit held in favor of the recipients, the State requested a rehearing.

Tuesday, the 4th Circuit said, “Nope.” The rehearing request was denied.

This means that the case will now return to District Court Judge Terrence Boyle for further proceedings and final determination.

To say that bringing a lawsuit enjoining the government from implementing policy is like David and Goliath is a mischaracterization of bringing a lawsuit against the government.

Bringing a lawsuit enjoining the government from implementing Medicaid policy is like the ant on the bottom of David’s shoe fighting Goliath.

Well, in this case, the ant is winning.

Health care providers who are being harassed by Managed Care Organizations and DHHS, take this as a lesson:

The ant can win.

About kemanuel

Medicare and Medicaid Regulatory Compliance Litigator

Posted on April 4, 2013, in Division of Medical Assistance, Harassment, Health Care Providers and Services, Injunctions, Legislation, MCO, Medicaid, Medicaid Appeals, Medicaid Eligibility, Medicaid Recipients, NC DHHS, North Carolina, Personal Care Services and tagged , , , , . Bookmark the permalink. Leave a comment.

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