Court Cases (Medicaid) « Medicaid
Court Cases and Publications
re: Medicaid Issues – Legal
Patricia E. Kefalas Dudek & Associates Court Cases re: Medicaid
- David v. Goliath: One Client's Fight for Attorney Fees and Costs (background article)
Medicaid Appeal: (attorney fees and costs case – 2009)
The need to enforce the Constitutional protections of due process is necessary in an effort to level the legal battleground for our clients that rely upon public benefits. The system is difficult to navigate and becomes even more of a struggle when the rules are ignored by the administrative agencies. Consider the unlimited legal representation and resources agencies have at their beck and call, versus the limited resources of a beneficiary on needs-based benefits. It is a very real time David v. Goliath situation.
- John Sullivan Update (December 2008)
I represented John Sullivan in an appeal seeking more state funding for Mr. Sullivan. For more info on this case, see Medicaid Does Not Have to Find In-Home
Services, Judge Rules and Ruling Won't Force In-Home Medicaid.
Related Court Documents: Policy Hearing Authority Decision – John Sullivan (2002)
- Petitioner's Brief for Judicial Review (redacted) (PEKD & Assoc.)
A Michigan Circuit Court brief regarding a client's request to use Medicaid-funded self determination benefits to facilitate his move to another state.
- Washington v. Debeaugrine (US District Court – Florida)
This case presents this issue: when a state official erroneously denies a Medicaid beneficiary his or her federal constitutional, statutory, and regulatory right to a hearing before the termination or reduction of benefits, must the beneficiary seek relief only in a state court, or may the beneficiary instead seek relief in a federal district court?
Patti's Comment: Important Medicaid waiver case which all advocates for folks who are on Medicaid or getting special education services should read!
Patti's Publications re: Medicaid
- Applications and the Appeals Process
- Attachment 1: Advocacy tips for Responding to The Deficit Reduction Act of 2005
Attachment 2: Single Points of Entry
Attachment 3: Ask Your Legislator to Vote
Attachment 4: Sample Cover Letter
Attachment 5: Frequently Asked Questions
Attachment 6: OCR Fact Sheet
Attachment 7: Discrimination Complaint
Attachment 8: Complaint and Jury Demand
- Medicaid Outside the Context of Long Term Care, Including Special Needs Trusts
- Attachments 1-3
Court Cases and Legal Info
- Anna C. Moore vs. Clyde L. Reese
- Patti's Comment: This case explains the STORY OF MY LIFE!! I spend hours fighting Bureaucratic Gobbledegook on behalf of people with disabilities and their families. I just do not understand how anyone can justify THIS TYPE OF RATIONED CARE. Where is the outrage over these potential “death panels”???
- On remand from the 11th Circuit Court of Appeals, a federal district court determines that Georgia's reduction of skilled nursing hours for a young woman with severe disabilities was arbitrary and capricious and based not on medical necessity but on "bureaucratic gobbledegook." Moore v. Cook (N.D.Ga., No. 1:07-CV-631-TWT, April 20, 2012).
- See PEKD Advocacy blog post for more info.
- Caregiver Child Exemption Applies Even Though Attorney-in-Fact Transferred House (Elder Law Answers)
North Dakota's highest court reverses a lower court ruling that the caregiver child exemption for the transfer of a house did not apply because the Medicaid applicant's attorney-in-fact transferred the house, not the Medicaid applicant himself. Dahly v. Anderson (N.D., No. 20120013, Aug. 30, 2012).
- Douglas v. Independent Living Center of Southern CA
- This is a Supreme Court case addressing whether Medicaid providers and beneficiaries may enforce the Medicaid provider payment provision, 42 U.S.C. § 1396a(a)(30)(A), in federal court on preemption grounds. Preemption cases argue that state laws are inconsistent with mandatory federal laws and, under the Supremacy Clause of the U.S. constitution, must yield.
- Brief for the U.S. as Amicus Curiae Supporting Petitioner – In a friend-of-the court brief, the United States Solicitor General wrote on behalf of the Obama administration asking the Supreme Court to find that Section (30)(A) cannot be privately enforced. According to the brief, enforcement should be the sole purview of the Secretary of Health and Human Services (who is statutorily authorized to terminate federal funding).
- Syllabus of Case (SupremeCourt.gov)
- Opinion – 2/22/12
- The arguments, while focusing on (30)(A), could spill over and affect private enforcement of other Medicaid Act provisions. It is beyond belief that this administration would take this position—one that slams the court house doors shut on low-income people, women and children, people with disabilities, and elderly people; that ignores the clear intention of Congress that Social Security Act programs like Medicaid are privately enforceable (see 42 U.S.C. § 1320a-2); and that ignores Supreme Court history recognizing the limited and secondary role of administrative enforcement (see, e.g., Blessing v. Freestone, 520 U.S. 329 (1997)) and the lack of an adequate enforcement scheme in Medicaid (see, e.g. Wilder v. Va. Hosp. Ass’n, 496 U.S. 498 (1990) and Rancho Palos Verdes v. Abrams, 544 U.S. 113, 121-22 (2005) (listing Medicaid as a statute where private enforcement is not foreclosed). Disappointing is too light a word.
- Patti's Comment: I am really so heartbroken by this betrayal by the Obama Administration. I was worried about this when they FAILED to address the fact that long term supports and services reform was the REAL crisis our nation is facing, and that is why MEDICAID is such a huge issues for the states. Please become informed on this issue. It could be you and/or your loved one who will need these services.
- Employees Providing Support Services to Medicaid Waiver Recipients are not Exempt from Federal Overtime Requirements
A U.S. district court rules that a company that provided support services to Medicaid waiver program recipients should have paid its employees overtime because the employees did not fall within the "companionship exception" to the Fair Labor Standards Act. Solis v. Firstcall Staffing Solutions, Inc. (W.D. Mo., No 08-0174-CV-W-ODS, Nov. 18, 2009).
- Medicaid Law: An Overview (Cornell University Law School)
- Medicaid Suit Could Determine Who Decides Care: Doctor or State (Law.com – 3/25/09)
Federal appeals court hears arguments in case that Medicaid managers say could impact states' flexibility and discretion in allocating resources.
Patti's Comment: This is an important case – Michigan did something similar to lots of children with disabilities by changing the definition of private duty nursing…stay tuned.
- Home and Community Services Copayment Equity Act of 2009
- Patti's letter to Senators in Support of HCSCE (3/9/09)
…"The Act will exempt dually eligible individuals living in home and community settings from prescription drug co-payments. Currently, under Medicare Part D, only individuals living in skilled nursing homes are exempt from prescription drug co-payments. This change is necessary, as assisted living is one of the fastest growing long-term care options for the elderly and disabled."
ALFA Commends Senator Bill Nelson's Commitment to Co-pay Equity for Home and Community Based Seniors (MedicalNewsToday – 3/6/09)