A U.S. district court dismisses a claim by a nursing home against the state for failing to evaluate a nursing home resident's Medicaid eligibility in a timely manner because the nursing home did not change the resident's status to permanent. Morningstar Care Center v. Zucker (U.S. Dist. Ct., N.D. N.Y., No. 5:15-CV-1470 (GTS/DEP), Sept. 27, 2016).
Darlene Huseby used Fidelis Care, a Medicaid managed care health insurance program in New York. Fidelis covers non-permanent stays in nursing homes if the care is medically necessary. Ms. Huseby entered a nursing home, but Fidelis refused to cover Ms. Huseby's care, and the nursing home applied for Medicaid on her behalf. The state did not make an eligibility determination on the application.
The nursing home sued the state, arguing that the state's failure to issue a timely determination on the application violated Ms. Huseby's rights. The state argued that the court should dismiss the claim because the nursing home never requested that Ms. Huseby's status be changed to permanent, so the state was not required to evaluate her Medicaid eligibility.
The U.S. District Court, Northern District of New York, dismisses the claim because there is no case or controversy to confer subject matter jurisdiction on the court. According to the court, "because Ms. Huseby's stay at [the nursing home] was non-permanent and [the nursing home] failed to properly appeal or request a fair hearing in response to Fidelis' denial of coverage, [the state's] duty to make an eligibility determination regarding Ms. Huseby's Medicaid benefits was never triggered."
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