Case Tossed Against Kansas for Not Issuing Medicaid Eligibility Within 45 Day Rule

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A U.S. district court rules 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, and 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. The state filed a motion to dismiss.

The U.S. District Court, District of Kansas, granted the motion to dismiss, holding that the applicants did not state 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 did not allege the state denied them any due process. The court also ruled that the Medicaid implementing regulation requiring a timely Medicaid eligibility determination did not create an individual right enforceable through a private cause of action.

For the full text of this decision, go to: https://ecf.ksd.uscourts.gov/cgi-bin/show_public_doc?2016cv2665-27

​Berger Estate & Elder Law P.A. has been serving Kansas City for over 30 years providing Trusted Council with Proactive Solutions. Call us today at (913) 491-6332, visit our website berger-lawfirm.com or stop by our conveniently located offices at 11233 Nall, Suite 140 Leawood, KS 66211 for more information.​

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