Lawsuit Claiming Medicaid’s Failure to Make Timely Eligibility Determinations Violated Federal Law Dismissed

A U.S. district court ruled that a group of Medicaid applicants do not have a private right of action to sue the state for not issuing Medicaid eligibility determinations with 45 days and that the applicants were not denied due process by the delay. Evangelical Lutheran Good Samaritan Society, Inc. v. Randol  (U.S. Dist. Ct., D. Ks., No. 16-CV-2665-DDC-GEB, July 20, 2017).

Twenty-one residents of a Kansas nursing home applied for Medicaid, Each patient plaintiff required 24-hour skilled nursing care. The state did not issue an eligibility determination within 45 days. Eventually, the state approved 10 applications and denied nine, while two applications are still pending.

The Medicaid applicants and the nursing home sued the state, arguing, among other things, that the state violated their due process rights and the federal law requiring states to make a timely determination of Medicaid eligibility. Medicaid’s implementing regulations, 42 C.F.R. 435.912(c)(3), require the state to make an eligibility determination within 45 days. Plaintiffs also asserted defendants violated the Americans with Disabilities Act (“ADA”) by denying benefits to the patient plaintiffs and unfairly discriminated against plaintiffs on the basis of their disabilities. Finally, plaintiffs asserted that defendant violated their Fourteenth Amendment due process and equal protection rights. The state filed a motion to dismiss.

The U.S. District Court, District of Kansas, granted the state’s motion to dismiss, holding that the applicants have not stated a claim upon which relief may be granted. According to the court, the applicants did not have a constitutionally protected interest in Medicaid benefits and have not alleged the state denied them any due process. The court also rules that the Medicaid implementing regulation requiring a timely Medicaid eligibility determination does not create an individual right enforceable through a private cause of action. The district court held as follows: “Section 435.912(c)(3) outlines the timeliness and performance standards for state Medicaid agencies, but it never confers a legal right or remedy for private individuals if state agencies fail to comply with these standards.”

For the full text of this decision, go to: Evangelical Lutheran Good Samaritan Society, Inc. v. Randol 

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(Adapted from an article published on the ElderLawAnswers website. Mr. Vanarelli is a founding member of ElderLawAnswers.)