Charles Strouchler, a former publicity agent for classical-music management companies, has such severe multiple sclerosis that he has to be washed, fed, secured in a wheelchair during the day and turned in bed at night. For the past 15 years, he said, he has been able to live at home only because Medicaid pays for aides to take care of him around the clock.
Earlier this year, he received a notice saying that his help was being cut to one live-in aide per day, who would sleep through the night, rather than two aides working for 12 hours each. Mr. Strouchler and others like him filed a class-action lawsuit, challenging reductions in care.
While not ruling on the merits of the case, a federal judge in Manhattan decided on Tuesday that the plaintiffs had a “substantial likelihood” of proving that New York City and New York State had violated federal law in cutting back on Medicaid-financed personal care for hundreds of New Yorkers like Mr. Strouchler since last year.
The judge, Shira A. Scheindlin, issued a preliminary injunction ordering the city to stop reducing or terminating so-called split-shift care for certain reasons, except when a physician had personally examined the patient and found a change in medical condition or if the city submitted a declaration that a mistake had been made.
The judge wrote that there was strong evidence that care had been reduced or terminated in many cases without proper notice to patients and because of confusing and contradictory interpretations of state rules for Medicaid, the government health care program for the poor. The city and state can appeal the ruling, reach a settlement with the plaintiffs or continue to fight the suit.
The city’s Human Resources Administration, which administers the Medicaid personal-care program, issued a statement on Wednesday saying, “While we respectfully disagree with some of the court’s finding, we will, of course, comply with the court’s order.” The State Health Department said it was reviewing the decision.
In her ruling, Judge Scheindlin suggested that budget pressures had pushed the city and state to try to cut costs of Medicaid by cutting down on personal care, a major factor in rising Medicaid costs in New York and across the country. But she said officials would be misguided if they were trying to cut those costs by administrative fiat rather than by changes in the law.“Indeed, reforming our health care system has been a dominant topic of the nation’s political discourse in recent years,” the judge wrote.
“While these goals may be laudable,” Judge Scheindlin continued, “administrators — even when faced with major budget crises — may not deprive citizens of the care to which they are legally entitled.”
The decision is the latest fallout from a suit filed in January 2011 by the United States attorney’s office in Manhattan accusing the city of overbilling Medicaid by tens of millions of dollars by authorizing 24-hour home care for people who did not qualify for it. Split-shift care can cost $150,000 per patient per year, but their advocates say it complies with federal law requiring disabled people to receive treatment in the least-restrictive setting.
New York City settled the lawsuit for $70 million last November, of which $14.7 million was awarded to a whistle-blower, Dr. Gabriel Feldman, who worked for an agency under contract to the city.
Soon after the settlement, agencies for the elderly and disabled were flooded with clients complaining that their 24-hour split-shift care was being reduced, said Ben Taylor, a lawyer for the New York Legal Assistance Group, one of the agencies that brought the latest lawsuit.
Between August 2011 and June 2012, 270 people filed administrative appeals of the city’s decisions to cut back their split-shift care, according to Judge Scheindlin’s decision. Of those, 262 people, or 97 percent, won their appeals, and the care was reinstated.
In one case, Judge Scheindlin said, split-shift care had been denied to a patient with only partial limbs who could not walk, on the ground that she needed only “some” and not “total” assistance using the toilet.
An additional 312 people whose split-shift care was cut did not appeal, according to the decision. The judge declined to reinstate their care, saying she needed more information on why they did not appeal.
In testimony before Judge Scheindlin, Mr. Strouchler said that he was “mortified” when he got the notice that his care was being cut. “I thought: ‘Oh my God, if they take my care away, you know, I will wind up in a nursing home. I know I won’t survive there.’ ” The aides, he said, “make my life livable.”