Federal Judge Rules in Favor of Residents Suffering Extreme Eligibility Delays due to Illinois Medicaid Application Backlog
CHICAGO, Sept. 14, 2017 /PRNewswire/ -- In a recently published order, Judge Elaine E. Bucklo with the United States District Court for the Northern District of Illinois, ruled in favor of a preliminary injunction requiring the Director of the Illinois Department of Healthcare and Family Services ("HFS"), Felicia Norwood, to make a determination by October 16th on certain Medicaid applications. These applications were filed by long-term care facilities on behalf of residents and have been pending for over 90 days. In some cases, the applications have actually been delayed a year or longer according to sb2 inc., a leading law firm in Medicare/Medicaid Eligibility and Reimbursement, representing the facilities and residents.
Judge Bucklo ruled that, "The state must provide medical assistance to eligible individuals with reasonable promptness, and HFS's own administrative delays may not prevent timely payment of claims." The judge also held that Illinois HFS must bring its claims processing and payment procedures into compliance with federal regulations.
The complaints arise from a large backlog of cases pending Medicaid review in the State of Illinois. The complaints allege that the backlog is due in part by a failure of Illinois HFS to use an electronic asset verification program (AVP) to determine eligibility for Medicaid in a timely fashion, according to Chad Bogar, Managing Partner of sb2 inc. These cases typically involve seniors that do not have the ability to pay for long-term nursing home care, and do not have the personal assets to cover care expenses.
In the order, Judge Bucklo wrote that, "The public has an interest in ensuring that Medicaid eligible individuals promptly receive necessary medical services. This, after all, is why Medicaid exists. Illinois elected to participate in the Medicaid program and to accept federal funds for the purpose of providing medical assistance to its needy citizens. There is a public interest in making sure the state's designated Medicaid agency complies with federal law."
About sb2 Inc.
sb2 inc. has a core philosophy aligned squarely with our clients' commitment to protect their elderly residents. To achieve this, the firm developed an approach to consider the entire network of variables that impact the revenue of long-term care facilities, and created the Revenue.Recognition.Recovery®. system to address every one. This proprietary system helps facilities to identify newly available sources of revenue—specifically from Medicaid and Medicare—to help build bottom lines. The system includes touchpoints such as internal policies and procedures, training, and legal services. Long-term care facilities that aggressively use all of these revenue sources are the ones that will chart their growth well into the future. For more information, visit www.sb2inc.com.
Contact:
Chad Bogar
212-203-1334
[email protected]
SOURCE sb2 Inc.
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