Court Settlement to Help Low-Income Children With Complex Medical Needs

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Court Settlement to Help Low-Income Children With Complex Medical Needs

By Natalya Estrada
California Health Report
April 24, 2019

A federal judge prelimarily approved a lawsuit settlement earlier this month that will require the state to better provide in-home health care to California children and young adults with complex medical needs.

More than 4,000 families are affected by the settlement.

In a class-action lawsuit against the California Department of Health Care Services, plaintiffs alleged that the state failed to provide thousands of low-income children with sufficient in-home nursing services—services that the state had previously determined to be necessary. The claims are based on federal Medicaid laws, which require states to ensure child beneficiaries receive all approved medical services, and the Americans with Disabilities Act, which requires states to provide services to those with disabilities in integrated settings.

The case reached a settlement in February and this month, the court granted preliminary approval of the settlement, requiring the state to give notice to families impacted by the services. This will, according to attorney William Leiner with Disability Rights California, give the families with children in need of these services a chance to weigh in on the actions before the settlement gets final approval.

As part of the settlement, the state Health Care department “accepts that it is ultimately responsible to help these families,” Leiner said. “In the future, every family that needs assistance, regardless of where they live, will get a case manager whose job will be to arrange for all approved nursing hours.”

Prior to the settlement, families were often given outdated referral lists or told to research in-home care options via Google or Craigslist, Leiner said.

“Obtaining private-duty nursing is a difficult and complicated process and for too many years families have received little to no support in securing the health care their children are entitled to receive,” he said.

These options were not feasible, according to Leiner who represented the child plaintiffs, identified as I.N. and J.B., in the case. I.N. is 7 years old lives with her adoptive family. She also has cerebral palsy and epilepsy, and needs daily in-home care services.

“(She) uses a wheelchair and receives food and nutrients through a feeding tube. She requires round-the-clock care,” Leiner said, adding that I.N. was prescribed 63 hours of in-home care a week, which was approved by the state of California. The other plaintiff, J.B. was approved for 135 hours per week.

The situation is not unique to the two children. Over 4,000 children and youth under the age of 21 require and have been approved to receive in-home nursing care through Medi-Cal, the state’s low-income health program. But a Health Care Services access study completed in 2016 said that nearly one-third of the hours given to these children and youth went unfilled.

“The state has lacked an effective system to arrange for needed nursing, instead placing the burden on families to provide the nursing care themselves,” Leiner said. The lack of services put the children at risk of being hospitalized or having to live in a nursing-care facility, he said.

Anthony Cava, a spokesperson for the Health Care Services agency, said the settlement, if approved, will provide families with a notice from their child’s care plan through the county California Children’s Services program or Waiver Agency.

In an email he wrote that the notice would inform families about the case-management services available to help find approved nursing services.

“The notice will also include information about how families can file complaints if they are unhappy with the case-management services they are receiving or are having problems finding private-duty nursing services,” Cava said.

 

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