New York Medicaid Ignores Requests for Services, Class Action Says

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Three New York Medicaid recipients have filed a class action lawsuit over allegations that their requests for additional care have gone ignored by the plans administering the state’s Medicaid program.

Plaintiffs Madeline Bucceri, Patricia Trujillo and Lourdes Lo are taking on the private, for-profit entities under the Healthfirst banner that have been taking over administration of managed long-term care under the New York Medicaid program.

They are also suing the New York State Department of Health Commissioner Howard Zucker.

The plaintiffs say that they, and thousands of other New Yorkers, are indigent and disabled, and depend on the health care services provided by New York Medicaid.

As their health declines and their need for services increases, they say Healthfirst has been ignoring their requests for additional care – a dereliction to which the state Department of Health has turned a blind eye.

“Each of the named Plaintiffs has asked for an increase in their home care services to address their many needs. … Defendants have either ignored their requests or used flawed systems of assessment and determination that systematically and unlawfully deny or reduce the needed services,” according to the class action lawsuit.

Plaintiff Bucceri, age 93, says she now lives alone after a lifetime of work and the deaths of her family. She suffers from arthritis, spinal stenosis, hypertension, incontinence and mental disorders. To live safely in her Staten Island home of 26 years, Bucceri says she depends on home health care from New York Medicaid.

When her hip and leg pain worsened, making walking even more difficult, Bucceri says her Medicaid plan administered by Healthfirst failed to adequately respond to her requests for additional hours of care. While waiting for a proper response, she says she was hospitalized twice and fell twice while home alone. Her incontinence and uncontrolled pain worsened.

A request for expedited processing sent months after she first requested additional care was met weeks later with an outright denial of her request, she alleges. Plaintiffs Trujillo and Lo tell similar stories of worsening health and requests for needed care effectively ignored.

The plaintiffs allege Healthfirst and Commissioner Zucker have violated the federal Medicaid Act by failing to provide necessary services and by failing to provide them promptly. They also raise due process claims challenging New York Medicaid procedures for handling claims.

The three plaintiffs propose to represent a Class consisting of “[a]ll current and future New York State Medicaid recipients who receive home care services through Healthfirst [managed long term care] plans.”

They seek a court order requiring Healthfirst to timely and effectively process all requests for increases in home health care.

The Medicaid recipients want a permanent injunction requiring the Department of Health to oversee Healthfirst’s New York Medicaid plans. They are also asking the court for reimbursements of attorneys’ fees and costs of litigation.

The plaintiffs are represented by attorney Jeffrey L. Kessler, leading a team of attorneys from Winston & Strawn LLP and The Legal Aid Society.

The New York Medicaid Class Action Lawsuit is Bucceri, et al. v. Zucker, et al., Case No. 1:16-cv-08274, in the U.S. District Court for the Southern District of New York.