A U.S. district court issues a 120-day stay in a case challenging Michigan's treatment of long-term care expenses incurred before a patient becomes eligible for Medicaid. The state requested the stay to allow the Centers for Medicare and Medicaid Services (CMS) to issue final approval of an amendment to the state's Medicaid Plan that would address the plaintiffs' claims. Miller v. Olszewski (E.D. Mich., No. 09-13683, Dec. 21, 2009).
Under federal Medicaid law, Medicaid recipients who receive long-term care services are typically required to contribute a majority of their income towards the cost of their nursing home care. But according to 42 USC 1396 (r)(1)(A)(ii), states must reduce the patient's monthly contribution to account for medical expenses incurred by the patient prior to Medicaid eligibility that are "not subject to payment by a third party, including . . . necessary medical or remedial care recognized under State law but not covered under the State Medicaid plan . . . subject to reasonable limits the State may establish on the amount of these expenses."
The plaintiffs in this class action lawsuit claimed that Michigan prevented them from deducting pre-eligibility long-term care expenses from their monthly patient contribution, in violation of federal law. In response, the state submitted evidence that it had already proposed an amendment to the state's Medicaid Plan whereby the state would allow deductions for long-term care expenses incurred up to three months before the patient became eligible for Medicaid. The state asked the court to stay the lawsuit for up to 120 days in order for CMS to approve a final version of the amendment.
The U.S. District Court for the Eastern District of Michigan issues the stay. The court finds that under the doctrine of primary jurisdiction, CMS should be allowed to approve or disapprove the state's policy before the court entertains the lawsuit. The court explains that "Congress has created this agency to regulate the subject matter at issue here -- and has specifically delegated authority to review state plans and amendments thereto for compliance with the applicable federal statutory and regulatory requirements -- and CMS's expertise in determining whether limitations on the amount of expenses are 'reasonable' should not be passed over."
For information on other cases involving the treatment of pre-eligibility medical expenses, click here.Did you know that the ElderLawAnswers database now contains summaries of more than 1,600 fully searchable elder law decisions dating back to 1993? To search the database, click here
Subscribe to the Knowledge Bank.
