Case Against Illinois for Not Processing Medicaid Applications Promptly Can Continue

A U.S. district court allows nursing home residents and providers to sue Illinois for not processing Medicaid applications in a timely manner. Nursing v. Norwood (U.S. Dist. Ct., N.D. Ill., No. 1:16-cv-9837, No. 1:16-cv-9842, No. 1:16-cv-9922, No. 1:16-cv-10255, No. 1:16-cv-10614, No. 1:17-cv-0104, No. 1:17-cv-0640, June 6, 2017).

A group of long-term care residents and nursing home operators sued the state of Illinois, alleging that it has failed to process Medicaid applications and provide Medicaid benefits with reasonable promptness to residents of long-term care facilities. The residents argued that the state has exceeded the 45 days or 90 days that the Medicaid regulations permit to determine applicant eligibility. The residents have either applied for Medicaid benefits and not received a decision on their applications or they have been approved for Medicaid, but not received any actual benefits. The providers are authorized representatives for the residents.

The residents and providers sought declaratory and injunctive relief requiring the state to process applications and provide benefits in accordance with the Medicaid Act's reasonable promptness provisions. The state filed a motion to dismiss, arguing, among other things, that the residents and providers do not have a private right of action under § 1983 and have not adequately stated a case for a violation of the timeliness provisions.

The U.S. District Court, Northern District of Illinois, denies the motion to dismiss, holding that the residents and providers have provided enough facts for the case to continue. According to the court, the Medicaid Act's reasonable promptness provision is unambiguously intended to benefit specific individuals and is not too vague. The court holds that the residents and providers stated a case for a violation of the reasonable promptness provisions by identifying "specific Medicaid-eligible patients who have not received timely eligibility determinations or timely medical assistance."

For the full text of this decision, go to: https://cases.justia.com/federal/district-courts/illinois/ilndce/1:2016cv09837/332551/50/0.pdf?ts=1496924428. 

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