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Delays in Processing of Medicaid Applications - What are Your Rights and Lawsuits Challenging Delays

Views: 3230
Posted: 23 Aug, 2012
by Valerie Bogart (New York Legal Assistance Group)
Updated: 17 Sep, 2014
by Valerie Bogart (New York Legal Assistance Group)

The Deadlines to Process Medicaid Applications in the Law

Federal 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. 

  • Determinations of eligibility for pregnant women and children under age 19 must be completed  within 30 days. 

  • Cases awaiting a disability determination have a 90-day time limit.  If the eligibility determination process for determining disability takes more than 90 days, on or before the 90th day, the applicant should be sent a written  statement stating the reasons for the delay.  When the applicant is eligible under a different category, Medicaid is authorized for the  interim period. 

42 USC Sec 1396a(a)(8); 42 C.F.R. Sec. 435.911; 18 NYCRR 360-2.4NYS Medicaid Reference Guide pp. 487-488;

See also 10ADM-04 - Elimination of the Personal Interview Requirement for Medicaid and Family Health Plus Applicants 

The Reality:  Delays Trigger Litigation

Despite 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 County

Contempt Motion Responds to Suffolk County’s Failure to Provide Promised Food and Medical Assistance Promptly (February 2012)(Maryann v. DeMarzo, Doe v. Blass)

Nassau County

NCLEJ and Colleagues Secure Settlement with Nassau County, NY, to Speed Provision of Food Stamps, Medicaid, and Cash Public Assistance (June 2011)(Dowdell v. Imhof)

NCLEJ Sues Nassau County NY For Delaying Food Stamps, Medicaid, and Cash Public Assistance to Hundreds Each Month(April 2010)

Columbia County

NCLEJ 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 County

Steuben 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)

NCLEJ, Western New York Law Center, and Empire Justice Center file class action challenging food stamp, Medicaid, and cash public assistance application delays in Steuben County, NY (July 2009)

Erie County

Martin v. Weiner (W.D.N.Y. 2008 settlement)

New York City

Reynolds 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

Also read
document When Documentation of Resources and Income is Required for Medicaid Applications & Renewals - and When is "Attestation" Enough?
document Where to Apply for Medicaid and Medicaid Home Care in New York City
document Elimination of Face to Face Interview for Medicaid and Family Health Plus applicants
document New Application Form (2010) Used for Medicaid, Child Health Plus and Family Health Plus in New York State
document Medicaid Disability Determinations - NYS Forms & Procedures (with updated forms July 2012)
document State Takes Steps to Implement Court Order Requiring Temporary Personal Care Services while Medicaid Application is Pending

Also listed in
folder Medicaid -> Applying For and Keeping Medicaid

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Tools for Choosing a Medicaid Managed Long Term Care Plan     Grievance and Appeal Contacts for Managed Long Term Care Plans


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