Federal Court Allows Major Disability Rights Case to Proceed, Citing Potential Violations in Home-Based Care

Concord, N.H.— A federal judge has ruled that Fitzmorris v. New Hampshire Department of Health and Human Services, a major disability rights case, will move forward, finding there is evidence that the State’s Medicaid-funded long-term care services are failing residents who rely on in-home services to live safely in their communities.

New Hampshire’s Choices for Independence (CFI) program is intended to help eligible older adults and people with disabilities live independently in their communities. Plaintiffs allege the State failed to properly administer the program, putting participants at serious risk of unnecessary institutionalization in nursing facilities and other institutions, in violation of federal law.

The U.S. District Court for the District of New Hampshire denied motions for summary judgment, concluding that material facts remain in dispute and must be resolved at trial. The Court found that Plaintiffs presented “ample evidence” that individuals are not receiving the services they are entitled to in the community, and “sufficient evidence” that the State’s failure to monitor service delivery in real time is contributing to and worsening these gaps.

The CFI program includes a range of services designed to support people in their homes, including help with daily activities such as cooking, cleaning, bathing, and toileting, as well as transportation and intermittent nursing care. When those services are delayed or denied, individuals can be left with no option but institutional placement.

“New Hampshire residents should not be forced into institutions because the State fails to follow the law,” said William Alvarado Rivera, Senior Vice President of Litigation at AARP Foundation. “The Court’s decision makes clear that older adults and people with disabilities are not receiving the services they need. We will continue the work needed to ensure our clients’ rights to live at home and in their communities are protected.”

"This order allows the Plaintiffs to keep pressing the State to fix our broken CFI system. People’s lives are at stake, and we remain determined to create a future where CFI participants can access the services they need to live independently," said Jennifer Eber, Litigation Director at Disability Rights Center-NH. "We urge the State to join us in this effort. Instead of spending millions of taxpayer dollars defending a flawed system, those resources should be invested in real solutions that protect and empower CFI participants."

The Court also emphasized the need for stronger State government oversight across the system, noting inadequate reimbursement rates and additional evidence that gaps in care were not effectively addressed. While case management agencies do play a critical role in coordinating services, the opinion highlights the role of the State in consistent monitoring to ensure participants receive necessary care.

The decision further underscores that strengthening the system is both critical for protecting individuals’ rights and also makes fiscal sense. The Court noted that home- and community-based care is significantly more cost-effective than institutional care, with the State spending far less per person through the CFI program than it does for care in nursing facilities.