1. Elder Law NYC: the Initial Reduction in Care
Many families providing round-the-clock supervision for relatives with severe cognitive impairments are suddenly confronted with a reduction in authorized home care hours.
This adverse determination typically follows a periodic needs assessment conducted by a Managed Long Term Care (MLTC) plan.
Navigating the complexities of elder law NYC is crucial to contest such decisions effectively.
Navigating the Notice of Decision
A client sought assistance after receiving a "Notice of Decision" from their mother’s MLTC plan.
The mother, diagnosed with advanced dementia, required constant monitoring from two aides working 12-hour shifts to ensure her safety.
Following a routine assessment, the plan determined that her care hours would be significantly reduced, leaving her without supervision for many hours each day.
This decision caused immense distress, as it placed the mother at a high risk of wandering and injury.
Understanding how to respond is a key aspect of elder law NYC.
2. Elder Law NYC: the Legal Basis for an Appeal
Under New York Social Services Law, Medicaid recipients are entitled to personal care services that are medically necessary to maintain their health and safety in their own home.
A reduction in care hours is unlawful if it fails to meet the individual's documented needs.
A proficient elder law NYC attorney builds a case based on this legal standard.
Challenging the Assessment'S Validity
The first step in an appeal is to scrutinize the assessment that triggered the reduction in care.
An elder law NYC lawyer would review the assessment for any inaccuracies or omissions regarding the patient’s condition.
In this situation, the assessment failed to properly document the mother's inability to self-direct, her high risk of falling, and her need for constant supervision to prevent harm.
The legal strategy involved demonstrating that the plan's decision was not supported by the medical evidence.
Preparing for the Fair Hearing
To successfully challenge the reduction, a comprehensive evidence package must be prepared for a Fair Hearing.
Law firms like SJKP can assist by gathering extensive medical records that document the patient's deteriorating condition.
They would also obtain detailed letters of medical necessity from the patient's treating physicians and specialists.
Preparing testimony from family members and the home health aides themselves is also a critical part of building a case under elder law NYC principles.
3. Elder Law NYC: Achieving a Favorable Fair Hearing Decision
A Fair Hearing is an administrative proceeding where a Medicaid recipient can challenge an MLTC plan's decision before an Administrative Law Judge (ALJ).
The goal is to present evidence proving the plan's decision was incorrect based on the recipient's medical needs.
Success in these hearings often depends on the quality of legal representation from an elder law NYC specialist.
Presenting a Compelling Case
At the hearing, an SJKP attorney could argue that the client's mother required 24-hour split-shift care to remain safely at home.
Evidence would be presented to demonstrate her complete dependence on aides for all Activities of Daily Living (ADLs), such as bathing, dressing, and feeding.
Testimony would establish her significant cognitive deficits, her inability to call for help in an emergency, and the constant risk of wandering.
This thorough presentation is a hallmark of effective elder law NYC advocacy.
4. Elder Law NYC: the Outcome and Its Implications
A successful appeal results in a binding decision that overturns the MLTC plan's reduction.
The Administrative Law Judge's ruling legally requires the plan to reinstate and continue providing the originally authorized level of care.
This outcome reaffirms the patient's rights under New York elder law NYC regulations.
Securing Long-Term Stability for the Family
By winning the Fair Hearing, the family was able to secure the necessary 24/7 care for their mother, ensuring she could remain safely in her home.
This victory provided immense peace of mind and restored the stability needed to manage her complex condition.
It underscores the importance of seeking counsel from an experienced elder law NYC professional when facing a reduction in essential home care benefits.
Challenging a reduction in Medicaid home care hours can be a daunting process for families already managing the stress of caregiving.
However, New York law provides a clear path for appeal through the Fair Hearing system.
The attorneys at SJKP have the experience and knowledge necessary to guide clients through every step of this process.
If your loved one's home care hours have been unfairly reduced, contact SJKP for a consultation to ensure their rights and safety are protected under elder law NYC.
20 Feb, 2026
