A federal district court holds that a nursing home suing on behalf of its residents has a private right of action to sue the state for violating federal Medicaid law regarding patient liability amounts. Westminster Nursing Center v. Cohen (U.S. Dist. Ct., E.D. N.C., No. 5:17-CV-96-FL, Nov. 22, 2017).
Medicaid recipients at a nursing home were required to pay some of their income to the nursing home as a patient monthly liability amount. The recipients missed their payments and incurred a negative account balance with the nursing home. The recipients applied for a deviation in monthly payments based on the arrearage in payments to the nursing home, but the state either denied their requests or did not respond, claiming that under state regulations an arrearage in patient monthly liability is not a type of necessary medical expense that must be deducted from patient monthly liability.
The nursing home, as the designated representative for the Medicaid recipients, sued the state, alleging violations of the Medicaid Act's medical assistance and nursing facility services mandate, among other things. Under the mandate, the state may reduce payments for long-term nursing home care if a resident has independent income, but the state may not consider amounts that the regulations allow a resident to set aside for other purposes, such as medical expenses. The state filed a motion to dismiss, arguing that the nursing home did not have a right to sue under § 1983.
The United States District Court, Eastern District of North Carolina, denies the motion to dismiss in part, holding that the medical assistance and nursing facility services mandate creates a private right of action that is enforceable under § 1983. The court rules that the federal Medicaid provision regarding Medicaid patient monthly liability amounts is "couched in mandatory, rather than precatory, terms."
For the full text of this decision, go to: https://s3.amazonaws.com/ELA/common/uploads/documents/16442-Westminster Nursing.docx
For a news account of the decision claiming that this is the first to recognize a skilled nursing provider's right to pursue a claim against a state agency based on its assignment of Medicaid payments, click here.
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