A U.S. district court in Ohio rules that the state does not have to deduct money a Medicaid recipient does not actually receive from the recipient's income when determining the patient liability amount. Carespring Healthcare Management, LLC v. Dungey (U.S. Dist. Ct., S.D. Ohio, No. 1:16-cv-1051, March 2, 2018).
A group of nursing home residents applied for Medicaid, and the state calculated the residents' patient monthly liability amount based the their income. In some cases, the residents' liability was more than the income available to the resident.
The residents named the nursing home as their authorized representative, and the nursing home sued the state on the residents' behalf, claiming that the state was incorrectly calculating the residents' liability. The nursing home argued that the state was including income in the calculation that the residents did not have access to, including spousal support payments and money that was misappropriated by relatives. The state filed a motion to dismiss, arguing that state law did not include a deduction for spousal support payments or misappropriated funds.
The U.S. District Court for the Southern District of Ohio grants the motion to dismiss, holding that federal law permits the state to choose what it deducts from income before calculating the patient liability amount. According to the court, "federal law explicitly contemplates that a Medicaid recipient’s income may be greater than actual money received each month. States have significant discretion to determine exactly which money not received is still counted as income, and Ohio has made that determination in compliance with federal law."
For the full text of this decision, click here.
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