As we head into the Thanksgiving holiday, we’re happy to share news about a successful pro bono partnership for which Legal Aid – and our clients – are thankful. For over a year now, Hogan Lovells attorneys have been handling personal care aide (PCA) cases referred from Legal Aid and have achieved significant results for their clients.
It began few years prior, when we started seeing an increase in recipients of PCA services – Medicaid-funded home health care services for persons with disabilities who need help with basic, daily activities such as bathing, cooking, and, cleaning – contacting Legal Aid. They needed help because their service hours had been reduced or terminated by the Medicaid agency for the District.
This increase came on the heels of the District changing the way that Medicaid beneficiaries are assessed for eligibility for PCA services and restricting the eligibility criteria. The restrictions were imposed, in part, in response to several cases of alleged fraud by some PCA service providers, including home health agencies billing for services that were not being provided. However, the response to the fraud cases led to many qualified beneficiaries’ experiencing unjustified reductions in and termination of PCA services, even though they played no part in any alleged fraud scheme.
Navigating the administrative appeals process in these cases is challenging, if not impossible, for clients to manage on their own – all the more so for clients who already need significant help with the most basic of daily living activities. As the volume of cases grew, we saw an opportunity to get a law firm partner involved, and Hogan Lovells was an obvious choice.
With a large health care regulatory practice, Hogan has made a special effort to partner with Legal Aid’s Public Benefits Law Unit on projects aimed at expanding access to health care for some of our most vulnerable clients. Most notably, the firm joined forces with Legal Aid in 2006 – following implementation of the Medicare Part D prescription drug coverage benefit – to create an annual pro bono project to help low-income Medicare beneficiaries (primarily disabled adults and seniors) with prescription drug plan selection and enrollment.
But over the last year, it is the firm’s work on PCA cases that has been particularly noteworthy. In one case, the Hogan team successfully negotiated with the D.C. Department of Health Care Finance (DHCF) to restore full services for a client whose PCA hours were reduced after he had been receiving the same level of services for over two decades. The client has several physical health disabilities, including blindness, and there had been no change in the client’s overall condition that would have justified a reduction in services.
In another case, Hogan Lovells represented a client who uses a motorized wheelchair due to disabilities resulting from polio. The client cannot bathe, dress, eat, or move around his home without assistance. The PCA service hours he was receiving were cut in half after he returned home from several weeks in a rehabilitation center. After the Hogan team submitted medical evidence supporting their client’s need for services, DCHF reversed its decision.
David Thiess, a senior associate at Hogan Lovells, works on these cases and plays a significant role in coordinating the firm project. “One theme that has emerged from our representation of clients whose PCA services have been reduced is that the clients’ disabilities and need for continued services have been assessed in a cursory and perfunctory manner,” said David. “Beneficiaries are then left to navigate a daunting administrative appeals process that is difficult to understand just to maintain the same level of services that they have required and relied on for years. Helping these clients has proven to be personally and professionally rewarding for our team.”
Legal Aid applauds David and the entire team at Hogan Lovells for making justice real for these clients!