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Yesenia

DRM represented “Yesenia,” who despite her severe physical disability, had maintained her job as an inclusion school teacher for the past 15 years with the assistance of 90 weekly hours of attendant care under Medicaid, first under a waiver program and then under Medicaid Community First Choice (CFC). Yesenia had also been able to purchase her own home. When DHMH terminated the self-directed option under CFC and transferred her services to an agency, the state reduced her hours to 77 per week but failed to send her written notice with appeal rights in accordance with the law. Yesenia’s ability to continue working, paying her mortgage and living in the community rather than a nursing facility was at risk, as she could not afford to pay for the additional care she needed and thus intended to quit her job unless she received the full 90 hours of care. She came to DRM when appealing a later request to restore her from 77 to 90 weekly hours. We represented her to get the Department of Health and Mental Hygiene (DHMH) to restore her to 90 hours pending the appeal hearing and advocate on the merits for the restoration of her approval for 90 hours. While DHMH did restore her to 90 hours until the hearing, they refused to reverse their decision on the merits. We referred the case to a pro bono attorney with limited experience and provided many hours of technical assistance to her on handling the case over several months. After negotiations, the week before the scheduled hearing, DHMH rescinded its decision to cut Yesenia’s hours and restored her to 90 hours/week.