In Alexander v. Choate, 469 U.S. 287 (1985), the State of Tennessee reduced from 20 to 14 the number of inpatient hospital days it would reimburse for Medicaid beneficiaries. A class action was brought under Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. § 794), claiming the limitation would have a disproportionate effect […]
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In Great-West Life & Annuity Ins. Co. v. Knudson, 534 U.S. 204 (2002), an ERISA plan bought an action to recover funds paid to settle an MVA involving Janette Knudson. The plan spent $411,157.11 on Janette’s medical expenses; all but $75,000 was paid by Great-West under a stop loss agreement. The plan included a reimbursement […]
In Sereboff v. Mid-Atlantic Medical Services, Inc., 547 U.S. 356 (2006), an ERISA Plan sued the plan beneficiaries when funds were distributed to the Sereboffs without first satisfying an ERISA lien. The ERISA plan sued for injunctive relief, requesting a temporary restraining order and preliminary injunction requiring the couple to retain and set aside at […]
42 U.S.C. § 1396 et seq. https://www.law.cornell.edu/uscode/text/42/chapter-7/subchapter-XIX 42 U.S.C. § 1396p https://www.law.cornell.edu/uscode/text/42/1396p 42 U.S.C. § 1396r-5 https://www.law.cornell.edu/uscode/text/42/1396r-5 42 C.F.R. Part 431 https://www.law.cornell.edu/cfr/text/42/part-431 42 C.F.R. Part 435 https://www.law.cornell.edu/cfr/text/42/part-435 42 C.F.R. Subchapter C https://www.law.cornell.edu/cfr/text/42/chapter-IV/subchapter-C 20 CFR 416.1110 et seq. (SSI – Income) https://www.ssa.gov/OP_Home/cfr20/416/416-1100.htm 20 CFR 416.1201 et seq. (SSI – Resources) https://www.ssa.gov/OP_Home/cfr20/416/416-1201.htm Program Operations Manual System https://secure.ssa.gov/apps10/ […]
“With the memory of the pandemic’s toll in nursing homes still raw, the COVID-19 relief law is offering states a generous funding boost for home- and community-based care as an alternative to institutionalizing disabled people.” However, funding for the current bill is temporary, “raising concerns it will have just fleeting impact…” For the full story, […]
This case presents the question whether a trust created with reference to the Federal Medicaid statutes — the Valerie R. Pecce Supplemental Needs Trust (2001 trust) — should be reformed due to mistake. According to the petitioner, Gino DiGiacomo, the 2001 trust incorrectly and unnecessarily provides that trust assets must first be used to reimburse […]
Medicaid, just one of the sets of rules applicable to most older adults, is one of the most complex laws ever enacted. Even Judges have difficulty understanding it. What follows are a few quotes from court decisions: “The Social Security Act is among the most intricate ever drafted by Congress. Its Byzantine construction, as Judge […]
The husband died six months after the decedent. The decedent had required nursing home care, and she received Medicaid assistance to pay for the care. The estate’s personal representative allowed $ 63,880 as a claim against the estate but disallowed $ 44,533. The county contended that it was entitled to full recovery because the value […]
Plaintiffs were a group of couples with one spouse in the nursing home and other spouse still in the community. In each case, the Community Spouse was the beneficiary of a Community Spouse Annuity Trust (“CSAT”). Some institutionalized spouses had been denied Medicaid, while others had applications pending. The Plaintiffs challenged the State’s treatment of […]
Guardians of two nursing home residents brought suit contending that the State erred by beginning a transfer penalty on the first day of the month after a transfer, rather than on the month of the transfer. The Court found the claims barred by the Eleventh Amendment. It dismissed the remainder of the Complaint for failure […]
