70 results for 'cat:"Medicaid"'.
J. Bland finds that the court of appeals improperly ruled in favor of a couple's estate in a Medicaid dispute arising out of the denial of assistance from the Texas Health and Human Services Commission. The couple argues that despite their living in an assisted living facility, their shared financial interest in real property should add to their resources. The court of appeals accepted their argument and upheld a reversal of the commission's denial. For the property to be included in the couple's resources, they would need to live in the home, as is required under federal law. Reversed.
Court: Texas Supreme Court, Judge: Bland, Filed On: May 3, 2024, Case #: 22-0437, Categories: Government, medicaid, Property
J. Milazzo grants a preliminary injunction to a 71-year-old widow with a medical condition and sole custody of her 6-year-old granddaughter. The Louisiana Department of Health is ordered to continue paying the woman’s Medicaid health premium while she challenges the state’s termination of her benefit based on its “size of the family” criteria that does not include children or grandchildren. Louisiana stopped paying the grandmother’s monthly Medicaid premium in early April 2024, based on its conclusion she lived in a one-person home, a finding that does not include the child, who is dependent upon her for financial support. Louisiana’s Medicaid manual limits the state’s family size criteria to a household of two - an applicant and an eligible spouse.
Court: USDC Eastern District of Louisiana , Judge: Milazzo, Filed On: April 30, 2024, Case #: 2:24cv728, NOS: Other Civil Rights - Civil Rights, Categories: Government, Health Care, medicaid
J. Hamilton finds that the lower court improperly dismissed the hospital's claim against the state because the private managed care organizations the state contracts with to pay Medicaid bills systematically delayed and reduced payments owed to the hospital for treating patients covered by Medicaid. The hospital has a viable right to have the state ensure timely payments from managed care organizations and this right is enforceable in this section 1983 actions against the state health agency's director. Reversed.
Court: 7th Circuit, Judge: Hamilton, Filed On: April 25, 2024, Case #: 21-2325, Categories: Government, Health Care, medicaid
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J. Rivera finds that the appellate division improperly held that changes to for-profit nursing homes' Medicaid rates could not be made retroactively because legislation authorizing the changes to help close a state budget gap specified an April 1 effective date, and new rates were not made retroactive when homes were notified months after federal approval. Meanwhile, the usual 60-day advance notice requirement was not applicable due to the urgency of the fiscal crisis. Reversed in part.
Court: New York Court Of Appeals, Judge: Rivera, Filed On: April 23, 2024, Case #: 31, Categories: Administrative Law, Civil Procedure, medicaid
J. Zahn finds that the trial court properly set aside a transfer of real property from two Medicaid recipients to their grandchildren. The Department of Health and Welfare was authorized to seek reimbursement for Medicaid benefits paid and to set aside the transfer since the grandparents' estates did not receive adequate consideration for the property. Affirmed.
Court: Idaho Supreme Court, Judge: Zahn, Filed On: April 11, 2024, Case #: 50302-2022, Categories: medicaid, Property, Wills / Probate
J. Wilkinson finds the lower court properly granted summary judgment to the agency. Under the Medicaid Drug Rebate Program, a drug manufacturer that increases its prices faster than inflation rises must reimburse Medicaid for the difference. These reimbursements are paid via rebates. Primarily, each drug’s rebate amount is usually determined based on its own original price and inflation clock, but not always. Congress has instructed in the Medicaid statute that some “line extension” drugs can be on the hook not only for their own price increases but also for the price increases of the drugs they evolved from. The agency promulgated a regulation that set forth criteria for what constitutes a line-extension drug that the pharmaceutical company claims expanded the definition of a line extension beyond what the Medicaid statute permitted. Each departure of the regulatory text is patently superficial, with no discernable effect on the term’s reach. Affirmed.
Court: 4th Circuit, Judge: Wilkinson, Filed On: April 10, 2024, Case #: 23-1457, Categories: Government, medicaid, Agency
J. Bevan finds that the Industrial Commission properly awarded medical benefits to an employee based on the full invoiced amount for the employee's medical expenses. Under this court's decision in Neel, the full invoiced amount is due if the workers' compensation surety denies a claim that the Commission subsequently finds is compensable. The employer and surety argued that Medicaid recipients should be excluded from the Neel full invoice doctrine, but doing so would pose a hardship for the most vulnerable employees. Also, the employee is not entitled to attorney fees on appeal because the appeal by the employer and surety was not frivolous. Affirmed.
Court: Idaho Supreme Court, Judge: Bevan, Filed On: April 2, 2024, Case #: 49940, Categories: medicaid, Attorney Fees, Workers' Compensation
Per curiam, the court of appeal grants the agency's petition for review of the Administrative Law Judge's ruling in this dispute over the alleged overpayment of Medicaid payments. The ALJ is to make specific findings of fact on each incident of overpayment that was identified in the final audit.
Court: Florida Courts Of Appeal, Judge: Per curiam, Filed On: March 20, 2024, Case #: 1D2023-0020, Categories: medicaid, Agency
J. Fisher finds that a former nursing home resident was properly deemed ineligible for Medicaid benefits during certain periods. The evidence offered by the home and her family failed to rebut the presumption that some asset transfers made during the statutory five-year "lookback" period were made to qualify for assistance. Affirmed.
Court: New York Appellate Divisions, Judge: Fisher, Filed On: March 14, 2024, Case #: CV-23-0858, Categories: medicaid
J. Egan finds that the lower court properly dismissed a petition challenging the finding that a nursing home owed $4.5 million in Medicaid overpayments because the former operator of the home brought the action, and lack of standing to challenge the overpayment demand had already been decided in an administrative hearing. Affirmed.
Court: New York Appellate Divisions, Judge: Egan, Filed On: March 7, 2024, Case #: 536191, Categories: Civil Procedure, medicaid
J. Wilkinson finds the lower court properly found the free-choice-of-provider provision of the Medicaid Act creates enforceable individual rights. South Carolina argued a recent high court ruling compels the conclusion that individual Medicaid beneficiaries cannot enforce the free choice-of-provider provision, but the ruling did not change the law to an extent that would call previous determinations into question. Affirmed.
Court: 4th Circuit, Judge: Wilkinson , Filed On: March 5, 2024, Case #: 21-1043, Categories: Government, Health Care, medicaid
J. Azrack throws out a class action challenging the New York health department’s alleged mishandling of applications for Medicaid assistance, claiming the department failed to provide adequate notice of the right to an expedited fair hearing and failed to timely determine a resident’s eligibility for benefits. The court finds she lacks standing to bring suit and declines to rule on the merits of her claims.
Court: USDC Eastern District of New York, Judge: Azrack, Filed On: March 1, 2024, Case #: 1:22cv1436, NOS: Other Civil Rights - Civil Rights, Categories: medicaid, Class Action
[Consolidated.] J. Gilson finds that the trial court properly dismissed claims contending pharmaceutical companies used free nurse and reimbursement support services to market drugs in order to submit inflated Medicare and Medicaid claims because the health centers lacked standing to act as relators, and the claims are nearly identical to similar federal complaints filed in Texas. Affirmed.
Court: New Jersey Appellate Division, Judge: Gilson , Filed On: March 1, 2024, Case #: A-2731-20, Categories: medicaid, Medicare, False Claims
J. Lindsey finds the trial court improperly enjoined the disability services funding agency from terminating its Medicaid waiver agreement with the company providing home-based and community care for those with disabilities. The company has not shown a likelihood of success on the merits because it did not challenge the validity of the Florida statute that requires the termination-without-cause provision in the parties' agreement it claims was unconscionable, signed under duress and violates federal Medicaid regulations. The trial court's injunction is reversed and the case is remanded for further proceedings. Reversed.
Court: Florida Courts Of Appeal, Judge: Lindsey, Filed On: February 28, 2024, Case #: 22-1744, Categories: medicaid, Agency
J. Chicchelly finds that a Medicaid recipient was properly denied judicial review after disputing services because Iowa Code 441-78.43 does not authorize stand-alone transportation services for program members receiving supported community living services that include transportation costs.
Court: Iowa Court Of Appeals, Judge: Chicchelly, Filed On: February 21, 2024, Case #: 20-0046, Categories: medicaid
J. Wiley finds that the trial court properly upheld the state's order for a hospital to include in the patient days it reports for Medi-Cal reimbursement the bed hold days at its long-term facility. The state's "Long-Term Manual" is more specific than the "Hospital Manual" about bed holds, through which beds are kept available for patients who are likely to return soon, and specific statutes control over general ones. Affirmed.
Court: California Courts Of Appeal, Judge: Wiley, Filed On: February 9, 2024, Case #: B316529, Categories: medicaid
J. Cole denies the government’s motion to compel a pharmacy chain to produce nearly 21,000 documents on its privilege log. This case is over whether the pharmacy chain, for years, kept government Medicare and Medicaid overpayments on patient prescriptions that it was supposed to have refunded. The government is now pursuing extensive discovery in the already six-year-old case, but the court finds that the pharmacy chain’s privilege log is so fundamentally flawed that it needs to be revised before the government can order the production of documents. Given the time it would take to complete such an overhaul, the court instead suggests the parties arrive at “a creative method for resolving the conflict” instead.
Court: USDC Northern District of Illinois, Judge: Cole, Filed On: February 2, 2024, Case #: 1:18cv6494, NOS: Other Statutory Actions - Other Suits, Categories: medicaid, Medicare, Discovery
J. Richman finds that the trial court properly upheld a county decision to treat a tax debtor's garnished Social Security payments as income in calculating her Medi-Cal eligibility. The garnished income, though it never passes through the tax debtor's hands, is "actually available" to meet her needs since the income actually exists instead of being fictional, theoretical, assumed or imputed. Affirmed.
Court: California Courts Of Appeal, Judge: Richman, Filed On: January 31, 2024, Case #: A164775, Categories: medicaid, Social Security, Tax
J. Ryan finds the lower court erroneously upheld family services' denial of Medicaid benefits to the long-term care resident. The rejection notice failed to include a required denial code that would have provided her with adequate information about why her claim had been refused. Additionally, the resident's assignment of several life insurance policies to a funeral home reduced the amount of resources she could allocate toward daily care at the long-term facility, which qualified her for Medicaid benefits. Reversed.
Court: Ohio Court Of Appeals, Judge: Ryan, Filed On: January 18, 2024, Case #: 2024-Ohio-160, Categories: Health Care, Insurance, medicaid
[Combined.] J. Reynolds Fitzgerald finds that the lower court properly found for the state and dismissed claims for mandamus relief by nursing homes seeking to have their appeals of Medicaid reimbursement rates processed. Such relief was not available because processing the appeals was a discretionary duty, not ministerial, in that it involved decisions on how quickly and in what order to take up the appeals. Furthermore, the nursing homes established no cognizable vested property interest in the appeals to support claims of due process violations. Affirmed.
Court: New York Appellate Divisions, Judge: Reynolds Fitzgerald, Filed On: January 18, 2024, Case #: 534801, Categories: medicaid