Medicaid Applicants Cannot Sue in Federal Court Over Whether They Can Deduct Pre-Eligibility Expenses from Income

A U.S. appeals court rules that a group of Medicaid applicants do not have a private right of action to sue in federal court over whether they can deduct their pre-eligibility nursing home expenses from their income. Nasello v. Eagleson (7th Cir., No. 19-3215, Oct. 6, 2020).

A group of nursing home residents in Illinois each incurred nursing home expenses, which they still owe. They applied for Medicaid, and the state approved their applications as long as they contributed a portion of their income to the cost of their care. The state did not deduct their pre-eligibility nursing home expenses from their income when determining how much they were required to contribute.

The applicants sued the state in federal court, arguing that Medicaid regulations require that prior medical expenses should be offset from the calculation of their income. The applicants sued under 42 U.S.C. § 1396a(a)(8), which provides that anyone wishing to apply for medical assistance shall have the opportunity to do so, as well as § 1396a(r)(1)(A), which requires the state to take medical expenses into account when determining income. The state filed a motion to dismiss. The district court https://attorney.elderlawanswers.com/medicaid-recipients-who-wanted-to-deduct-pre-eligibility-expenses-from-income-do-not-have-right-to-sue-in-federal-court-17399 granted the state’s motion to dismiss, and the applicants appealed, arguing that they were being discriminated against on the basis of disability.

The United States Appeals Court, Seventh Circuit, affirms, holding that the applicants do not have a private right of action to sue in federal court under § 1396a(r)(1)(A). The court holds that while they do have a private right of action under § 1396a(a)(8), because “their grievance concerns not the time at which these ongoing benefits are paid but the amount of those benefits,” they did not state a claim under § 1396a(a)(8). The court also notes that the fact that their “benefits are not as high as they want is not a form of discrimination.”

For the full text of this decision, go to: http://media.ca7.uscourts.gov/cgi-bin/rssExec.pl?Submit=Display&Path=Y2020/D10-06/C:19-3215:J:Easterbrook:aut:T:fnOp:N:2591604:S:0