[This article was originally published on September 21, 2012. The links were updated on August 24, 2018.]
A disabled Florida Medicaid long-term care recipient has filed a class action lawsuit over the state’s refusal to allow her to deduct from her patient pay amount nursing home costs that she had incurred prior to becoming Medicaid-eligible. Representing the recipient is a group of elder law attorneys and litigators who sued Maryland over its similar refusal to deduct “pre-eligibility medical expenses” (PEMEs). That case was settled in 2010 for $16 million. A similar case against the District of Columbia resulted in modifications to the way the District calculates Medicaid recipients' co-payments.
Gabrielle Goodwin, 61, is disabled and resides in a Florida nursing home. Ms. Goodwin’s first application to Florida’s Department of Children and Families (DCF) for Medicaid long-term care benefits was denied. A second application was approved on March 16, 2012, with benefits retroactive to December 1, 2011. Her application indicated that she had PEMEs, including amounts owed to the nursing home during her period of pre-eligibility (i.e., before December 1, 2011) of $70,608. DCF calculated her monthly patient responsibility amount to be $1,032.41, refusing to deduct from her total available income the $70,608 in unpaid nursing home expenses, which would have reduced Ms. Goodwin’s patient responsibility amount to $0.00 for 68.4 months. Ms. Goodwin appealed this refusal and a DCF hearing officer ruled in favor of the agency.
Ms. Goodwin has now filed suit in state court against the Florida Agency for Health Care Administration and its DCF on behalf of herself and all other similarly situated individuals who received Medicaid long-term care benefits in the past four years or who will receive benefits in the future and will have medical expenses to pay that were incurred before they became eligible for Medicaid. The suit charges that the Florida Program Policy Manual, on which DCF case workers rely, imposes restrictions on PEME deductions, including that nursing home expenses are not deductible, that violate federal and state law. (To read the complaint, click here.)
“There may have been a little uncertainty about the PEME rule seven years ago [when suit was brought against Maryland], but there are now authoritative federal agency and state and federal court decisions confirming that the PEME deduction is required,” according to Ron M. Landsman, the Maryland attorney and ElderLawAnswers member who first raised the issue. “It is now well-established law.”
Besides Landsman, the attorneys for the plaintiff also involved in the Maryland suit are Cyril Smith and William Meyer of the firm Zuckerman Spaeder LLP; and longtime National Academy of Elder Law Attorneys member René H. Reixach, Jr., of the Rochester, New York, firm of Woods, Oviatt & Gilman LLP. Also involved with the Florida case are Florida elder law attorneys Lauchlin T. Waldoch and Jana McConnaughhay of Waldoch & McConnaughhay, P.A., as well as Robert W. Pass, Martha W. Chumbler and Donald R. Schmidt of Carlton Fields, P.A.
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