Price v. Medicaid Dir.

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Hilleger, suffering from dementia, heart problems, and arthritis, moved into a Cincinnati assisted-living facility. For four years, Hilleger paid the center’s $4,300 monthly fee. When she ran out of money, her daughters paid the fee while Hilleger applied for Medicaid assistance through Ohio’s assisted-living waiver program. When the agency determined that Hilleger was financially eligible, Medicaid began paying for her care. Saunders suffered a fall. Her stress fractures and dementia prevented her from returning home. She moved to an Ironton assisted-living center and applied for Medicaid assistance The agency authorized benefits 18 days later. Saunders’s daughter paid the costs for those 18 days. Hilleger and Saunders filed a putative class action, alleging that Ohio’s omissions of Medicaid coverage for the first 18 days of Saunders’s assisted-living costs and for the first three months of Hilleger’s costs violated 42 U.S.C. 1396a(a)(34); violation of the notice requirements of 42 U.S.C. 1396a(a)(3) and failure to provide Medicaid assistance with reasonable promptness (42 U.S.C. 1396a(a)(8)). The district court certified the proposed class and granted plaintiffs summary judgment. The Sixth Circuit reversed. The plaintiffs had standing to pursue only their claim with respect to retroactive benefits; other claims could not be redressed by the relief sought. Section 1396n(c)(1) permits Medicaid funding only for assisted-living services that are authorized by a preceding service plan. View "Price v. Medicaid Dir." on Justia Law