In this case, the United States District Court for the Southern District of New York granted  summary judgment for plaintiffs in a lawsuit alleging that the State of New York failed to render final decisions following Fair Hearings within the ninety-day period following the filing of Fair Hearing requests as required by federal and state law. Menking v. Daines, Docket No. 09-CV-4103 (S.D.N.Y., September 21, 2013)

Plaintiff Marie Menking, a New York resident, was an inpatient at Fort Tryon Center for Rehabilitation and Nursing (“Fort Tryon”), a nursing home, from fall 2005 through late spring 2006. After plaintiff’s application for Medicaid coverage of the nursing home costs incurred at Fort Tryon was denied by a August 23, 2007 Notice, plaintiff filed a timely request for a Fair Hearing to appeal the denial. A Notice of Fair Hearing was issued dated January 17, 2008, 106 days after the request, and a fair hearing was scheduled on February 7, 2008, 127 days after the request was filed. After a number of adjournments requested by plaintiff, the fair hearing concluded on November 7, 2008. As of April 27, 2009, the date on which plaintiff filed her federal complaint, plaintiff had not received a decision on her Fair Hearing.

Plaintiff, on behalf of herself and a certified statewide class of applicants for, or recipients of, Medicaid benefits, brought this lawsuit against the New York State’s Department of Health and the State Office of Temporary and Disability Assistance asking the Court to enjoin defendants’ routine practice of failing to render final decisions following Fair Hearings within the ninety-day period following receipt of claimants’ requests for Fair Hearing as required under federal and state law.

After completing discovery proceedings, plaintiff moved for partial summary judgment, and defendants cross-moved for summary judgment. Defendants argued that whether plaintiff had suffered an actual injury due to defendants’ conduct, a prerequisite to her standing to bring a claim, was an issue of disputed material fact. In response, the Court ruled that plaintiff had standing because unlawful administrative delays in scheduling and holding Fair Hearing past the required ninety-day period constituted an “actual injury.”

Further, the Court held that the matter was ripe for summary judgment because it was uncontested that plaintiffs experienced substantial delays in scheduling Fair Hearings and in rendering decisions after the Fair Hearings. The Court found the delays to be “in clear violation of the ninety-day limit mandated by 42 U.S.C. § 1396a(a)(3), 42 C.F.R. §431.244(f), and SMM § 2902.10.” Moreover, the court found that defendants’ rate of noncompliance with the ninety-day requirement as a percentage of total number of statewide Medicaid Fair Hearing decisions rendered was substantial: 38.2% for 2006, 41.7% for 2007, 35.7% for 2008, and 25.4% based on partial information for 2009. As a result, the Court entered summary judgment on behalf of plaintiffs.

After ruling for plaintiffs, the Court directed counsel for the parties to confer and inform the Court how they proposed to resolve the action.

The case is attached here – Menking v. Daines