Federal judge preliminarily approves class action settlement for California’s failure to arrange Medi-Cal in-home nursing care for children

Over 4,000 children in California are eligible for in-home nursing -- many don’t receive the care they are prescribed
Press Release

San Francisco, Calif., (April 8, 2019) – A federal judge granted preliminary approval for settlement of a class action lawsuit that will enable children and youth with complex medical needs to get the in-home nursing they need to remain healthy and safe. The judge’s ruling will allow the state to inform over 4,000 affected families about the settlement, giving them a chance to weigh in before granting final approval.

The case was filed on May 24, 2018 by two children, I.N. and J.B., against the California Department of Health Care Services (DHCS), claiming that the state failed to fulfill its commitment to provide them and thousands of other Medi-Cal beneficiaries like them with sufficient Medi-Cal in-home nursing services to keep them safely at home.

“Obtaining private duty nursing is a difficult and complicated process and for too many years families have received little or no support in securing the health care their children on Medi-Cal are entitled to receive,” says William Leiner, an attorney with Disability Rights California, one of the firms that brought the case.  “Under this settlement, the Department of Health Care Services accepts that it is ultimately responsible to help these families.  In the future, every family that needs assistance will get a case manager whose job will be to arrange for all approved nursing hours.”

Plaintiff I.N. is seven years old and lives with her adoptive family. Due to cerebral palsy and epilepsy, she needs help with all of her daily needs, uses a wheelchair, and receives food and nutrients through a feeding tube. She requires round the clock care, including 63 hours per week of in-home nursing care as prescribed by her doctor and approved by the Medi-Cal program. But she has always received far less than the 63 hours she needs. Her mother hopes that the settlement, which will improve the services available to families like hers, will change that.  “With this settlement, I am hopeful that my family and others like mine will finally receive the help we need to obtain nursing care for our children.”

I.N.’s story is not unique. More than 4,000 Medi-Cal-eligible children have been approved by the state to receive Medi-Cal in-home nursing care. Yet because the state lacks an effective system for arranging nursing, many children make do with far fewer hours than they need, which creates an unacceptable risk of medical complications, hospitalization, and placement outside of the family home. According to a 2016 DHCS study, 29 percent of authorized Medi-Cal in-home nursing hours go unstaffed.

Sarah Somers, an attorney with co-counsel National Health Law Program, has litigated similar cases across the nation. “Under federal Medicaid law, states are required to do more than simply authorize services. They have an affirmative obligation to arrange for those services to be provided to the children who need them. We are pleased that California has recognized this responsibility and is taking action to improve their system so that children will be better served.”

Robert Newman, General Counsel with co-counsel Western Center on Law and Poverty, sees a moral, legal, and fiscal imperative for the state to act. “DHCS settled this case quickly, because they understood the gravity of the circumstances for thousands of families. Enabling children to remain safely at home and avoid costly hospitalization is the right thing to do.”

To learn more about this case and the Plaintiffs, read the complaint here.

 

Disability Rights California (DRC) is the protection and advocacy agency for the state of California.  DRC works to advance the rights, dignity, equal opportunities, and choices for all people with disabilities through impact litigation, policy advocacy, investigations, training and outreach. For more information, visit www.disabilityrightsca.org.

Founded in 1969, the National Health Law Program (NHeLP) protects and advances the health rights of low-income and underserved individuals and families. NHeLP advocates, educates and litigates at the federal and state levels. Our lawyers and policy analysts stand up for the rights of the millions of people who struggle to access affordable, quality health care. We are guided by the belief—a challenge—that each generation should live better than the last. www.healthlaw.org

Western Center on Law & Poverty fights for justice and system-wide change to secure housing, health care, racial justice and a strong safety net for low-income Californians. Western Center attains real-world, policy solutions for clients through litigation, legislative and policy advocacy, and technical assistance and legal support for the state’s legal aid programs. Western Center is California’s oldest and largest legal services support center. www.wclp.org.