A U.S. district court rules that a class of Medicaid applicants who are suing Illinois for violating the reasonable promptness provisions of the Medicaid Act are entitled to a preliminary injunction because evidence shows that thousands of applications have been pending for more than 90 days. Koss v. Norwood (U.S. Dist. Ct., N.D. Ill., No. 17 C 2762, March 29, 2018).
Several nursing home residents who applied for Medicaid and did not receive a timely response on their eligibility sued the state for violating the reasonable promptness and notice provisions of federal Medicaid law. The residents moved for class certification, arguing that there are thousands of applications in Illinois that are either pending a decision on admission or deemed eligible for Medicaid but not yet admitted to the system for more than 90 days.
The state filed a motion to dismiss, claiming that the residents did not have a private right of action to sue under the reasonable promptness provision of Medicaid law. The residents asked for a preliminary injunction.
The U.S. District Court, Northern District of Illinois, denies the motion to dismiss, grants class certification, and grants the preliminary injunction. The court certifies a class of "All individuals who on or after February 1, 2015, have applied to be determined to be eligible for long-term care Medicaid benefits from the State of Illinois, and have not received a final eligibility determination or a notice of an opportunity for a hearing within 45 days of the date of application in non-disability cases or 90 days in disability cases." Citing the evidence of thousands of applications pending for more than 90 days, the court rules that a preliminary injunction is appropriate. According to the court, the class has shown a likelihood of success on the merits and irreparable harm because even though Medicaid applicants are protected from being discharged from a nursing home, members of the class face the risk of denial of medical care from providers outside a nursing home.
For the full text of this decision, go to: https://cdn.elderlawanswers.com/common/uploads/documents/16622-Koss.docx
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