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Tag Archives: Medicaid

Administrative – Medicaid – Civil Rights – ADA & Rehabilitation Act – Constitutional – Eleventh Amendment Immunity (access required)

Kobe v. Haley Plaintiffs seek a declaratory judgment that Governor Haley’s predecessor acted wrongfully to deprive them of Medicaid benefits. Such a declaration would constitute retrospective relief; hence, Governor Haley is entitled to immunity under the Eleventh Amendment.

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Medicaid Crisis (access required)

Medicaid Crisis

When the parents of a severely disabled girl in North Carolina settled a medical-malpractice case for $2.8 million, the state stepped in and tried to take a nearly $1 million cut for prior Medicaid payments. It was an ordinary request for reimbursement, but the girl’s parents – who face an estimated $40 million in future medical costs for their daughter – decided to contest the state’s lien. And two weeks ago the Fourth Circuit Court of Appeals ruled in their favor.

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The kidney transplant that almost wasn’t (access required)

Kidney transplant

Ashley Quiñones showed up at the Legal Aid office in Pittsboro, N.C. in desperate need of a good lawyer – and a good kidney. She had received a lung transplant more than 10 years earlier, but her kidney function was deteriorating quickly. In March 2010 her kidney transplant was approved, and all that was left was Medicaid’s agreement to pay. “Every appointment and treatment the doctors requested, all the dialysis, had always been approved,” she said. So Quiñones was stunned when the letter arrived last August informing her that the kidney transplant was denied.

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Administrative – Medicaid – Waiver Program – Mental Retardation – Definition – Onset Date (access required)

Doe v. South Carolina Department of Health & Human Services South Carolina adopted a broad definition of mental retardation in S.C. Code Ann. § 44-20-30, using language that parallels the Supplemental Security Income definition, which includes the onset of impairment before age 22. In Regulation 88-210, the Department of Disabilities and Special Needs (DDSN) interpreted that definition in a manner consistent with the Social Security Administration; thus, DDSN’s interpretation of § 44-20-30 in its policy guidelines - requiring an onset of impairment before age 18 — directly conflicts with Regulation 88-210 and should be disregarded.

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Administrative – Medicaid – Lost Funding – Drug Company Settlement – Federal Government Share (access required)

W.Va. Dep’t of Health & Human Resources v. Sebelius The 4th Circuit upholds an administrative ruling that sustained a disallowance of federal funding for West Virginia’s Medicaid program based on the state having failed to credit to the federal government a share of its settlement against a drug company for allegedly overcharging; the unambiguous text of the governing statute authorized the disallowance and agency approval of the amount disallowed was neither arbitrary nor capricious.

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