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Judge's ruling temporarily stops changes planned by DHHS

Posted February 19, 2010

N.C. health, mental health, Medicaid generic
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— An administrative law judge on Friday stopped changes to how the state Department of Health and Human Services allots care.

The Association for Home and Hospice Care of North Carolina Inc. filed suit against the state asking that changes to how care is determined be stopped.

Judge Don Overby on Friday placed a preliminary injunction on the Division of Medical Assistance from using a new scoring system to determine how many hours of in-home care each of the more than 37,000 current patients can receive.

Overby extended a temporary restraining order because he said it was likely the association would succeed in a hearing scheduled for April 26 on the merits of the case.

Nurses, family members and caregivers told Overby that the review would result in drastic cuts that would "cause tremendous harm to the individuals who depend on these services and that many would be forced into hospital emergency rooms and more expensive institutional care," association CEO Tim Rogers said in the statement released Friday.

DHHS is under pressure to reduce costs because of budget cuts made by the state legislature. The agency admitted that the review of care was spurred by budgetary concerns.

In his ruling, Overby found association members would be harmed if DHHS proceeds with the planned cuts.

But Overby said the division could write letters to 3,030 Medicaid personal care service recipients who don't appear to meet minimum eligibility requirements because the agency's review looks valid.

“We could not be more delighted with the court’s decision in ruling on behalf of 37,000 PCS patients,” Rogers said.

“The court stated emphatically medical necessity is the key to who should receive care."

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  • almagayle50 Feb 25, 2010

    This is a very interesting ruling by this judge. I had him several years ago in a hearing. He accepted testimony from a DHHS expert witness whose only expertise was in substance abuse. My son is developmentally delayed. He ignored testimony from my son's doctor who has followed him for over ten years. He did not enter a default judgement in our favor, when the attorney from the AG's office failed to submit her Findings of Fact in time. But, as I said in the hearing, the state has a policy which is the new governmental version of why buy the cow, when you can get the milk for free. I doubt he would be ruling against the state at this point if the people involved were receiving care from their mothers.