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30A Complaint & Memo of Law in PCA Case

Date: 
08/19/2021
Author: 
Kate Symmonds, MLRI
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This complaint seeks judicial review of the MassHealth Board of Hearings' final decision denying the appellant a fair hearing to contest a 50% reduction in her PCA hours because the reduction had been requested by  the  personal care management agency (PCM)  and approved by MassHealth; the HO limited the hearing to only those hours requested by the PCM that MassHealth denied . At the administrative hearing, the appellant's attorney argued that the reduction in hours was based on MH policies & was state action under Mansfield v. Commission of the Department of Public Welfare 40 Mass.App.Ct. 1 (1996), and  therefore within the scope of the fair hearing. The hearing officer ruled that the PCM's action was based on a private medical decision, and therefore the BOH had no authority to review it. The appellant then filed this complaint joining claims for judicial review under M.G.L. c.30A §14, and for a violation of due process under 42 U.S.C. §1983. The case is Severs v. EOHHS.

Attached are the Complaint and Answer, the Plaintiff's Motion for Judgment on the Pleadings and her Memorandum of Law and a Stipulation of Dismissal.   Note the Memo of Law briefs the basis for opposing the boilerplate defenses MassHealth sometimes raises in 30A appeals.

We are engaged in negotiations with MassHealth about changing its policies to comply with Mansfield, Please let MLRI know if you have a case raising these issues. 

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