Federal Court Approves Settlement in Medicaid Case

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Tags: Press Release

Raleigh, NC: A federal District Court today approved the settlement of Pettigrew v. Brajer, taking an important step to ensure older adults and people with disabilities who need assistance can stay at home rather than moving to an institutional setting.

The class action lawsuit against the State of North Carolina challenged the denials and terminations of Medicaid-funded personal care services provided to tens of thousands of North Carolinians in their homes.  The settlement requires the Medicaid agency to use comparable practices and procedures for assessing a person’s need for the service as well as reinstate or reassess some class members who were previously denied or lost the service.

National Health Law Program attorney Elizabeth Edwards welcomed the court’s approval of the settlement. “As a result of this settlement, people living in their homes will no longer find it harder to get personal care services than they would if they lived in an institution.

The lawsuit, initially named Pashby v. Cansler, was filed in 2011, alleging that the state violated federal Medicaid law and the Americans with Disabilities Act by determining eligibility for personal care services under more restrictive criteria for persons living at home than for those who live in institutional settings known as adult care homes. In December 2011 U.S. District Judge Terrence Boyle ruled in favor of plaintiffs, issuing a preliminary injunction ordering the state agency to restore lost services until the state Medicaid agency and its contractor ended their discrimination based on the setting where the Medicaid beneficiary resides. The Court found that the plaintiffs faced the threat of having to go into institutions to get the care they needed. In March 2013, the U.S. Court of Appeals for the Fourth Circuit affirmed the District Court order, ruling for the first time that the Americans with Disabilities Act prohibits discrimination in the Medicaid program which results in a serious risk of institutionalization.

“This case was important because the court held that the desire to save resources does not allow the state to require Medicaid recipients to enter institutions to receive the services they need,” said Disability Rights North Carolina attorney John Rittelmeyer.

Doug Sea, an attorney at Legal Services of Southern Piedmont in Charlotte, added “Thousands of North Carolina’s most vulnerable citizens who need these services to safely remain in their homes have been protected and had their services restored.”