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Lawsuit: Major LI Medicaid provider for disabled to close

Sen. Kemp Hannon seen here on Wednesday, Jan.

Sen. Kemp Hannon seen here on Wednesday, Jan. 6, 2016, in Albany, says GuildNet illustrates a "budding problem" in the state's health care system. Credit: AP / Mike Groll

ALBANY — A federal lawsuit filed on behalf of disabled Medicaid patients says the biggest provider of long-term care services on Long Island may close soon without any plan in place to protect patients.

The suit, filed last week by the New York Legal Assistance Group, seeks to force the state Health Department to develop a care plan for thousands of patients who could be affected if GuildNet Inc. closes, as expected.

GuildNet, which covers about one-third of Medicaid long-term care patients on Long Island, wrote to clients June 1 telling them it intended to close and advising them to choose a new health plan, the lawsuit says.

The Health Department subsequently sent a letter stating GuildNet could not close without a transition plan in place and, therefore, patients didn’t have to switch plans by June 1.

But the state still hasn’t developed that plan and patients are concerned that GuildNet might close this month, says NYLAG, which advocates for the disabled and others.

“We’re under the impression GuildNet will still close as soon as it can. It just couldn’t do it June 1,” Elizabeth Jois, a NYLAG attorney, said about the claim filed in U.S. District Court for the Eastern District of New York.

GuildNet has about 2,000 enrollees in Suffolk County, and 1,700 in Nassau, the lawsuit says. It also serves patients in Westchester County.

Health Department spokeswoman Jill Montag didn’t comment on the lawsuit. But she said the agency is working on a “smooth transition” for patients — noting that 20 health care plans are available for downstate consumers — and made clear GuildNet expects to cease operations.

“GuildNet remains in the Managed Long Term Care program, but has informed the department of its intent to end operations in these three counties,” Montag said. “The department is working with GuildNet to ensure a smooth transition.”

A spokesman for GuildNet said no one was available to comment. Last fall, GuildNet announced it was not enrolling any new patients, citing “very substantial deficits.”

Jois said the scenario might be repeated with other companies that cover long-term care patients. She noted that HomeFirst, another provider, announced recently it will close in Suffolk County.

“We don’t think this is a rare event,” Jois said. “We think we’ll see more people left in the lurch if the state doesn’t have a plan to handle” what happens when a long-term care company closes. The lawsuit asks the court to ensure that enrollees don’t endure a reduction in care hours if forced to transition to another health care plan.

Sen. Kemp Hannon (R-Garden City) has said that GuildNet illustrates a “budding problem” in the state’s health care system: Home care services say they aren’t getting adequate reimbursement rates from state government and nursing homes aren’t getting timely payments.

Hannon, chairman of the Senate Health Committee, wrote to the Health Department last month, urging it to distribute a fact sheet and create a dedicated phone line to help GuildNet patients find new coverage.

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