The Deadlines to Process Medicaid Applications in the LawFederal and state law set time limits for processing a Medicaid application. The federal Medicaid Act requires eligibility to be determined with "reasonable promptness." A determination of eligibility for Medicaid must generally be made within a 45-day time period, with two exceptions.
42 USC Sec 1396a(a)(8); 42 C.F.R. Sec. 435.911; 18 NYCRR 360-2.4; NYS Medicaid Reference Guide pp. 487-488; The Reality: Delays Trigger LitigationDespite the clear time limits in law and regulation, many local districts take much longer time to process Medicaid applications. Various lawsuits have been filed over the years seeking to enforce compliance with the federally mandated time limits. Information about some of the lawsuits in NYS can be found at the links below. The links include contact information for plaintiffs' counsel. Suffolk CountyContempt Motion Responds to Suffolk County’s Failure to Provide Promised Food and Medical Assistance Promptly (February 2012)(Maryann v. DeMarzo, Doe v. Blass) Nassau CountyNCLEJ and Colleagues Secure Settlement with Nassau County, NY, to Speed Provision of Food Stamps, Medicaid, and Cash Public Assistance (June 2011)(Dowdell v. Imhof) Columbia CountyNCLEJ and Colleagues Sue Columbia County, NY for Systemic Failure to Process Food Stamp, Medicaid, and Cash Assistance Applications in a Timely Fashion (June 2011)(Travis v. Mossman) Steuben CountySteuben County, NY Agrees to Speed Up Issuance of Food Stamps, Medicaid Assistance, and Cash Public Assistance to those Hard Hit by Recession (November 2009)(Kari C. v Mullen) Erie CountyMartin v. Weiner (W.D.N.Y. 2008 settlement) New York CityReynolds v. Giuliani, 35 F. Supp. 2d 331 (S.D.N.Y.1999), modified on other grounds, 43 F. Supp.2d 492 (S.D.N.Y. 1999) (not specifically addressing application delay processing, but NYC’s failure to permit prospective applicants to file their applications for FS, MA, and PA on the first day they visit a NYC Job Center and the failure to do separate MA and FS determinations for those applicants whose PA application is denied or withdrawn). See news about procedures in planning stages to authorize personal care services while Medicaid application is pending
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