US District Court orders Ohio to begin paying retroactive Medicaid payments for Assisted Living

Just out — summary judgment was granted to the plaintiffs in an Ohio Medicaid case in Federal District Court for the Southern District of Ohio called Kathryn A. Price et al. vs Medicaid Director et al.. The plaintiffs were represented by counsel through the nonprofit organization Justice in Aging  Inc. Here’s the decision.

At issue was the rewuirements of 42 USC 1396a(a)(34).

Through a detailed analysis of the governing federal statute, the Court found that the federal law requires the retroactive payment of unpaid assisted living bills for three months preceding the date of eligibility. The court held that the Ohio’s regulation therefore violated the controlling federal statute, and that Ohio needed to bring its practices into compliance with deferral law: ” Ohio’s rules setting the effective date of assisted living waiver eligibility as beginning only after an application is filed and after the State approves a service plan, assesses financial qualifications (as in Mrs. Hilleger’s case), or determines the level of care qualifications thwart Congress’s intent as expressed in § 1396a(a)(34). These rules permit the State to evade the retroactivity requirement by simply selecting a definition of “eligibility” that relies on a post-application event. Defendants’ interpretation effectively eviscerates the “(or upon application would have been)” provision of § 1396a(a)(34), which contemplates a retrospective view of an individual’s circumstances had that person actually applied for Medicaid when he or she received the care or services.”

The Court further said, ” As explained above, the clear language of the statute requires States to provide retroactive Medicaid benefits to eligible individuals applying for assisted living waiver benefits.Congress did not waive § 1396a(a)(34) retroactivity for home and community-based services waivers under § 1396n(c).” The decision paves the way to review other state’s practices to see if they are out of compliance as well.


Call us to prepare and file your Medicaid applications for Assisted Living, nursing homes and home care, and for asset protection plans, and appeals of Medicaid denials … 732-382-6070

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