Legal Aid and Winston & Strawn Fight for Managed Care Hours for Disabled Woman in Federal Court
MONDAY, JULY 25, 2016

The Legal Aid Society and Winston & Strawn LLP filed a lawsuit in the U.S. District Court for the Southern District of New York on behalf of a Staten Island woman suffering with a rare degenerative disease who has been denied vital health services.

Tonia Carcioppolo, who suffers from Friedreich's ataxia, a rare autoimmune disease that progressively destroys the nervous system, receives only 49 hours of weekly home care from her Medicaid Managed Long Term Care plan provided by Senior Health Partners which has continually refused to give her the nearly round-the-clock care she desperately needs. She needs help using the restroom, bathing, dressing and eating. Her teen-age daughter is her caretaker. While attempting to get out of her wheelchair, Ms. Carcioppolo has fallen several times and suffered serious injuries. At one point, she lay in her own urine for hours. She is fearful that she will be institutionalized.

The lawsuit charges that Ms. Carcioppolo's rights under the Medicaid Act, the Americans with Disabilities Act and due process protections are being violated. The suit notes Senior Health Partners receives fixed amount per enrollee and has a financial incentive to minimize the service hours provided to enrollees. Pointing to a review of over 100 fair hearing decisions last year, the lawsuit says Senior Health Partners has a track record of not giving severely disabled Medicaid recipients the home care and services they require.

The lawsuit follows a report that analyzed approximately 1,000 hearing decisions by a state agency between June 2015 and December 2015. Prepared in part by The Legal Aid Society , the study found a sharp jump in attempted service cuts by plans like Senior Health Partners. Though the plans prevailed only about one percent of the time, the report recommended a series of steps to address unjustified service cuts.

Ms. Carcioppolo is represented by the following Legal Aid attorneys: Judith Goldiner, Attorney-in-Charge of the Civil Practice’s Law Reform Unit; Kenneth Stephens, supervising attorney in the Law Reform Unit; Rebecca Novick, Director of the Health Law Unit; and Belkys Garcia, a Staff Attorney in the Law Reform Unit. At Winston & Strawn, she is represented by John Aerni, Jeffrey Amato and Jeffrey Kessler, Partners at the firm.

The Daily News reported on the lawsuit and quoted Ms. Carcioppolo, refusing to be put in a nursing home against her will. “I’m not going into an adult day care. I’m staying right where I am with my daughter."

Daily News
Provider denied health services to disabled woman to pocket money
By Victoria Bekiempis
July 25, 2016

A wheelchair-bound Staten Island woman is at risk of being institutionalized because her home healthcare provider won’t give her enough time with an attendant — so it can pocket Medicaid money, a new lawsuit alleges.

Tonia Carcioppolo, 41, suffers from Friedreich’s ataxia, a rare disease that progressively ravages the nervous system, as well as scoliosis and overactive bladder.

Carcioppolo requires help using the restroom, bathing, dressing and eating. Her main caretaker is her 17-year-old daughter.

She has received home healthcare services from Manhattan-based Senior Health Partners since fall 2015, and has begged for more than the 49 hours per week now allotted to her because she needs nearly round-the-clock care.

Carcioppolo’s daughter returns home from work around 10 p.m. during the week, seven hours after her aide leaves at about 3 p.m. — so she has repeatedly fallen and broken bones trying to get to the bathroom.

At least twice, Carcioppolo languished in her own urine for hours, her lawyers said.

“I said, ‘What do I do when my aide leaves and I have to go to the bathroom?’” Carcioppolo recalls asking Senior Health Partners. “They said go to the bathroom before she leaves, do everything.”

“They asked me if I had diapers,” she said. “I asked them for healthcare and it’s like talking to a wall.”

The company, which receives a per-patient payment from Medicaid issued by the New York State Department of Health — thought to be around at least $3,400 per month — has refused despite Carcioppolo’s legal right to medically necessary assistance, the suit alleges.

These Medicaid funds pay “a fixed amount per enrollee without regard to the number of hours of home care Senior Health Partners provides... Thus, Senior Health Partners' financial incentive is to minimize the number of hours of home care that it provides to enrollees, such as Ms. Carcioppolo,” the lawsuit states.

Carcioppolo’s lawsuit, brought by the Legal Aid Society and Winston & Strawn, will be filed Monday, her lawyers said.

“I know eventually, I keep going to the hospital with broken body parts, they are going to try and place me in a nursing home against my will,” a fearful Carcioppolo said. “I’m not going into a state home — I’m not going into a nursing home. I’m not going into an adult day care. I’m staying right where I am with my daughter.”

“Senior Health Partners has a record of frequently having its home care hour determinations overturned through the State-administered fair hearing process,” the lawsuit also charges.

Carcioppolo’s lawsuit comes several days after the New York Times reported on Senior Health Partners’ cuts to aide hours in “hundreds” of homes.

Asked about Carcioppolo’s allegations, Senior Health Partners said, “Due to privacy concerns, Senior Health Partners cannot comment on specific members.”

The state Department of Health said it could not comment directly on the case, but defended managed long-term care.