Medicaid Consumers for Continuity of Care v. McDonald

CourtDistrict Court, S.D. New York
DecidedApril 24, 2025
Docket1:25-cv-00565
StatusUnknown

This text of Medicaid Consumers for Continuity of Care v. McDonald (Medicaid Consumers for Continuity of Care v. McDonald) is published on Counsel Stack Legal Research, covering District Court, S.D. New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Medicaid Consumers for Continuity of Care v. McDonald, (S.D.N.Y. 2025).

Opinion

UNITED STATES DISTRICT COURT D DO AC TE # : F ILED: 4/24/20 25 SOUTHERN DISTRICT OF NEW YORK MEDICAID CONSUMERS FOR CONTINUITY OF CARE, ANN WEGMAN, CARMEN RODRIGUEZ, AND MELISSA SPENCER, 1:25-cv-00565 (MKV) Plaintiffs, OPINION & ORDER GRANTING -against- MOTION TO DISMISS & DENYING MOTION FOR PRELIMINARY JAMES V. MCDONALD in his capacity as INJUNCTION the Commissioner of the New York State Department of Health, Defendant. MARY KAY VYSKOCIL, United States District Judge: Plaintiffs Medicaid Consumers for Continuity of Care (“MCCC”), Ann Wegman, Carmen Rodriguez, and Melissa Spencer bring this action against James V. McDonald in his capacity as the Commissioner of the New York State Department of Health (“NYS DOH ”) asserting claims under the Americans with Disabilities Act, 42 U.S.C. § 12132 (“ADA”), the Rehabilitation Act, 29 U.S.C. §§ 701 et seq., the Medicaid Act, 42 U.S.C.§ 1396a(a), Title VI of the Civil Rights Act of 1964, 42 U.S.C. § 2000d (“Title VI”), and the Fourteenth Amendment of the U.S. Constitution alleging violations of Title 42, Section 1983 of the United States Code (“Section 1983”). [ECF No. 1 (“Compl.”)]. Plaintiffs moved for a preliminary injunction to suspend and enjoin provisions of the challenged April 2024 amendment to Section 365-f of the New York Social Services Law (the “CDPAP Amendment”) pending the resolution of the instant suit. [ECF No. 5]. McDonald opposed the motion for preliminary injunction and cross-moved to dismiss Plaintiffs’ claims. [ECF No. 26]. For the reasons set forth below, the motion to dismiss is GRANTED and the motion for preliminary injunction is DENIED. FACTUAL BACKGROUND1 I. The CDPAP Amendment

The Consumer Directed Personal Assistance Program (“CDPAP”) is a New York Medicaid program through which Medicaid beneficiaries (or “consumers”) who require home care can recruit and hire their own Personal Assistants (“PAs”) to provide such care. Compl. ¶¶ 3, 28; N.Y. Soc. Serv. Law § 365-f; 18 N.Y.C.R.R. § 505.28. Pursuant to CDPAP, consumers also hire Fiscal Intermediaries (“FIs”) to assist with administrative tasks involved in employing PAs. Compl. ¶ 5. FIs onboard PAs, keep track of their time, bill Medicaid insurance companies for PA services, collect Medicaid reimbursement, and pay PAs’ wages and benefits. Id. There are currently approximately 280,000 consumers and 600 FIs in the state. Id. ¶¶ 6, 8. The NYS DOH is responsible for implementing CDPAP. Id. ¶ 9. Pursuant to a provision in the New York State Budget for State Fiscal Year 2024–25, New

York’s CDPAP will transition to a single, statewide FI (the “CDPAP Amendment”) (the “CDPAP Amendment”). Compl. ¶¶ 7, 54. The CDPAP Amendment states that “[e]xcept for the statewide fiscal intermediary and its subcontractors, as of April [1, 2025], no entity shall provide, directly or through contract, fiscal intermediary services.” Id. ¶ 56; N.Y. Soc. Serv. § 365-f (4-a-1)(a). Consumers and their PAs are required to enroll with the statewide FI before PAs may be paid for their services. Compl. ¶¶ 99–100, 112. II. The Parties & Public Partnerships, LLC

1 The facts are taken from the Complaint [ECF No. 1 (“Compl.”)], as well as “evidence from outside the pleadings” which the Court may consider on a motion to dismiss under Rule 12(b)(1). See Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009); Doherty v. Bice, 101 F.4th 169, 172 (2d Cir. 2024), cert. denied, —U.S.—, 145 S. Ct. 381, 220 L. Ed. 2d 144 (2024). Defendant James McDonald is the Commissioner of the NYS DOH and is responsible for the administration, enforcement, and implementation of the CDPAP Amendment. Id. ¶ 22. Public Partnerships, LLC (“PPL”) was hired to function as the statewide FI. Id. ¶ 8. Over thirty FIs have subcontracted with PPL to continue providing FI services. Def. Reply at 4; Perrin Decl. ¶ 62;

Bassiri Decl. ¶ 41. At the time of briefing, PPL was considering subcontracting with another 20 FIs. Perrin Decl. ¶ 62. Plaintiffs Ann Wegman and Melissa Spencer are consumers who receive at home care from PAs under CDPAP. Id. ¶¶ 19–20. Matilde Loarte is a consumer who suffers from dementia and receives at home care from PAs under CDPAP. Id. ¶ 21. Plaintiff Carmen Rodriguez is Loarte’s daughter and her “CDPAP designated representative.” Id. ¶ 21. Plaintiff MCCC is a member organization consisting of consumers, which was formed in response to the CDPAP Amendment. Compl. ¶¶ 13, 18-21, 23. Rose Jones is a CDPAP consumer and a member of MCCC. Jones Decl. ¶¶ 2, 13–14. The president of MCCC, Ken Sternfeld, is also a CDPAP consumer. Sternfeld Decl. ¶¶ 2, 5, 11.

Plaintiffs allege that CDPAP consumers will be injured by the CDPAP Amendment. Compl. ¶¶ 114, 162, 224; Wegman Decl. ¶¶ 5, 8; Spencer Decl. ¶¶ 5, 8, 14; Rodriguez Decl. ¶¶ 6, 16–18; Jones Decl. ¶¶ 13–14; Sternfeld Decl. ¶¶ 2, 5, 11. The Plaintiffs allege that they and their PAs may fail to enroll before the designated deadline, and thus their PAs will go unpaid for their services, or PPL will pay PAs less than they are currently paid or be unable to pay PAs at all. Compl. ¶¶ 114, 120–122, 127, 142, 162. Plaintiffs state that “if personal assistants are not reliably paid in full and on time, they will not be able to continue in their role as personal assistants and consumers will suffer a loss in care and risk having to be institutionalized.” Sternfeld Decl. ¶ 10; Compl. ¶¶ 162, 165. For instance, Plaintiff Wegman states that “if PPL fails to pay my personal assistants consistently and on time, it will force them to seek employment elsewhere.” Wegman Decl. ¶¶ 10. Wegman goes on to state that “[i]f my personal assistants quit it is highly unlikely that I will be able to find acceptable new assistants in time to avoid a lapse in care” and “[i]f I do not have in home support, I would need to seek care from a nursing facility or hospital.” Id. ¶ 12.

The other plaintiffs and MCCC members make similar allegations. See Rodriguez Decl. ¶¶16–18; Spencer Decl. ¶ 8, 14–17; Jones Decl. 11, 13–14. Plaintiffs also allege that the CDPAP Amendment will cause them to lose their preferred FI. Compl. ¶¶ 149–50. Many consumers are unaware of the requirement to register with PPL. Compl. ¶ 114. The three individual plaintiffs and Rose Jones attest that they were unaware of the mandatory transition to PPL until they were contacted by an advocate to discuss suing to stop the CDPAP Amendment. Pl. Reply at 20 (citing Wegman Decl. ¶ 9; Rodriguez Decl. ¶ 14; Spencer Decl. ¶ 13; Jones Decl. ¶ 10). The President of MCCC attests that “many, many people in New York State do not know what is happening” and attests he knows of at least five consumers who are unaware of the CDPAP transition, but confirms that none of these consumers are MCCC members. Sternfeld Decl. ¶¶ 6,

16.However, Ms. Rodriguez did receive some outreach notifying her of the CDPAP Amendment and transition. Rodriguez Decl. ¶ 13; Rodriguez Reply Decl. ¶¶ 4–7. Specifically, she received three emails regarding the transition to the statewide FI and an automated call from PPL that stated she would receive a call from an enrollment specialist. Rodriguez Decl. ¶ 13; Rodriguez Reply Decl. ¶¶ 4–7. She did not receive such a call. Rodriguez Reply Decl. ¶ 7. Plaintiffs assert that the rate of consumer enrollment with PPL is “abysmal.” Compl. ¶ 110.

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Medicaid Consumers for Continuity of Care v. McDonald, Counsel Stack Legal Research, https://law.counselstack.com/opinion/medicaid-consumers-for-continuity-of-care-v-mcdonald-nysd-2025.