Judge orders IL state agencies to move quicker on applications for long-term Medicaid benefits

By Dan Churney | Apr 3, 2018

The Illinois Department of Human Services has 90 days from when basic Medicaid recipients apply to determine if they are eligible for long-term Medicaid, or they will be automatically eligible for the long-term benefits, a federal judge has ruled.

In so ruling, the judge brushed aside concerns from state officials the time limit will encourage applicants who may otherwise be ineligible to game the sytem.

The March 29 ruling was laid down by U.S. District Judge Joan Gottschall in Chicago. The ruling favored a group of elderly women in their litigation against state social service agencies.

In April 2017, Alma Koss, Mary Small, Lessie Harris and Wanda Wente filed a class action against Felicia Norwood, secretary of the Illinois Department of Human Services, and James Dimas, director of the Illinois Department of Healthcare and Family Services. Plaintiffs were 68 and older, describing themselves as “impoverished or disabled.” Wente has since died.

Robert H. Farley Jr.  

Medicaid is a federally funded program administered by states, which provides medical aid for people of low income.

Plaintiffs were already eligible for basic Medicaid, but they needed to apply for long-term benefits to pay for their care in nursing facilities or supported living facilities. They complained their applications had undergone delays of 20 to 60 months, during which their bills piled up, because the IDHS was laggard in processing the applications.

In Koss' case, she alleged her ophthalmologist refused to continue treatment because of nonpayment, allegedly resulting in Koss losing her vision.

Plaintiffs also presented statements by care facilities that delays put the facilities in a financial and administrative bind.

IDHS argued many delays are beyond their control, such as an applicant’s failure to respond to requests for additional documents. IDHS also noted it has to deal with “voluminous” documents when handling applications.

A few months after the suit was filed, plaintiffs' applications were approved, and IDHS said the matter was moot and should be dropped. However, Judge Gottschall ruled the case should proceed for the benefit of potential class action members.

Plaintiffs asked for a preliminary injunction ordering IDHS to determine long-term eligibility within 90 days. Gottschall granted the request.

The judge noted applicants for long-term Medicaid must first be eligible for basic Medicaid. From there, Gottschall pointed out Medicaid regulations require “reasonable promptness” in determining Medicaid eligibility, with 90 days considered reasonable.

“Undisputed evidence in the record here shows that thousands of applications remain pending beyond those deadlines,” Gottschall observed.

In addition, Gottschall found it “plausible” the delays are not related to the mass of documents IDHS said it must wade through, or applicants' tardiness in furnishing those documents.

As a consequence, applications for long-term benefits must be processed in 90 days or else eligibility is automatically presumed and conferred.

IDHS expressed worry such automatic eligibility will turn Medicaid into an “estate planning tool,” with “presumptive eligibility incentivizing applicants to file incomplete applications, leave out documents, drag their feet on document requests, and otherwise game the system.”

Gottschall also certified the case as a class action.

Plaintiffs have been represented by the Naperville firm of Robert H. Farley, Jr., Ltd. and the Lane Powell PC firm of Seattle.

Defendants have been represented by the Illinois Attorney General's Office.

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Organizations in this Story

Illinois Department of Healthcare and Family Services Illinois Department of Human Services Lane Powell Robert H Farley Jr U.S. District Court for the Northern District of Illinois

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