Judge allows class-action status in Illinois Medicaid delay case

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Seniors in Illinois who have faced considerable delays in receiving their Medicaid coverage — including one woman who claims she went blind waiting for eye care — can sue the state, a judge ruled last week.

U.S. District Judge Joan B. Gottschall certified the class to include all individuals who applied for Medicaid since February 1, 2015, and had been determined eligible for long-term care benefits by Illinois but had not yet received a final eligibility determination or a hearing notice within 45 days in non-disability cases or 90 days in disability cases.

“The declarations of (nursing facility) operators here show that each has had several applicants who died or were discharged while awaiting decisions on their applications,” the judge noted, adding that those involved in the case should be presumed eligible because of the state's alleged failure to comply with the Medicaid Act's time requirements.

The case originated with four women ages 68 to 90, all residents of nursing homes and supportive living facilities, who sought Medicaid coverage through the state in 2015 and 2016. After submitting additional paperwork as requested and, in at least one case, applying repeatedly, the women argued that they were not receiving benefits after the required period.

Part of the case revolves around a technical oversight or backlog by the state, which must both deem the applicants eligible and enter that eligibility into a computer system to initiate coverage and payments.

The women claimed they were unable to pay for certain types of care without coverage, including their nursing home bills, optometrists' costs and prescriptions. One has withdrawn from the case, and another has since died.

But in a decision rendered Thursday, Gottschall said others could join in the remaining plaintiffs' case.

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