Disabled student wins battle vs. NJ Medicaid; won't have to drop out of Georgetown

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ASBURY PARK, N.J. – Anna Landre got the good news late last week: New Jersey’s Department of Human Services is backing off on cuts to her Medicaid plan that would have forced her to drop out of Georgetown University.

The former Freehold Township High School valedictorian, who has a progressive muscle disease that requires the use of a motorized wheelchair, will continue to receive the assistance of a personal care aide 16 hours a day instead of a reduction to 10 sought by insurer Horizon NJ Health and the state’s Division of Medical Assistance and Health Services.

WATCH: Landre discusses the issue in the video atop this story 

The difference would have forced Landre – who needs an aide to get in and out of bed, can’t use the bathroom, can’t receive the necessary respiratory protocol for her ailing lungs – to leave campus and return home to live with her mother. She owns a 3.9 grade point average through two years at Georgetown and has landed an internship with the U.S. State Department for this summer.

That was averted Friday when Landre signed a settlement agreement offered by the Department of Human Services, ending a yearlong battle. Her story received national attention after an administrative law judge sided with Landre and deemed the reduction “arbitrary” – only to have that ruling overridden by a New Jersey Medicaid administrator.

Under the new settlement agreement, which was obtained by the Asbury Park Press:

• DHS approves Landre’s use of personal care assistance (PCA) for 112 hours per week, which is the same level of care she’s had all along while at Georgetown.
• Landre is no longer required to return home every three months for a check-in health assessment, which necessitated her buying round-trip train tickets in the middle of each semester. Now those appointments will take place once per year.
• Landre agrees to drop her appeal of the case.

“It’s a big relief that I’m no longer in a state of crisis, but this only helps me, this agreement,” Landre said Monday. “There is so much more to be done. There are plenty of people who have to keep dealing with this until we fix it.”

There is a clause in the settlement stating that it should not be interpreted as an admission of wrongdoing or liability, or constitute a precedent in any subsequent related matter involving these or any other parties.

That last part bothers Landre, whose cause picked up the support of several state legislators as well as U.S. Rep. Andy Kim, D-N.J.

“I was thinking of not signing the settlement,” she said. “I was worried that it would make us lose all of our leverage for reform.”

She said state Sen. Vin Gopal, a Democrat whose 11th district includes part of Monmouth County, reassured her by saying that, “no matter what happens we will do legislation on this, to change this.”

One focus of any legislation, Landre said, will be reworking and clarifying how PCA allowances are calculated. Another would be creating a task force to work that out, one that would include representatives from disability advocacy groups and people who receive PCA benefits (or caregivers of those who receive PCA benefits).  

“Getting input from people who actually use the PCA hours is just a no-brainer,” Landre said. “We all know these hours don’t translate into the amount of help DHS and our insurance companies say it does.”

Such legislation, she said, also should allow PCA beneficiaries who are college students living on campus to conduct required nonmedical appointments remotely.

“I also would like to see consequences for insurance companies who repeatedly pursue cuts that are found to be in the wrong (by judges),” she said. “If they lose their hearing but there are no consequences, they’ll just try for another cut next year.”

Follow Jerry Carino on Twitter: @njhoopshaven.