Claims and Bad Faith Law Blog

Work Requirements to Impose on Medicaid Recipients ARE BACK!

Work requirements are popular in some quarters to impose on disabled people, the elderly, and children who receive Medicaid.  This is a repeat of an earlier time.

As of July 1, 2023 there was actually still one state with work requirements for Medicaid recipients, Georgia:

            The first Trump administration approved work requirements in 13 states.  Only Georgia's program, which started on July 1, 2023, is in effect.  A Medicaid work requirement launched in Arkansas was halted by a court order in 2019.[1]

Like a bad movie, we apparently have to do this again.  Stay tuned.

[1] Andy Miller, Renuka Rayasam and Sam Whitehead, Democratic Senators Ask Watchdog Agency to Investigate Georgia's Medicaid Work Rule, KFF Health News (online Dec. 18, 2024), https://kffhealthnews.org/news/article/georgia-medicaid-word-requirement-democrats-gao-investigate/.

 

Case law on these issues is set out in § 18D:16, Volume 2 of CATASTROPHE CLAIMS / INSURANCE COVERAGE FOR NATURAL AND MAN-MADE DISASTERS (Thomson Reuters November 2024 Edition, 2025 Supplements in process).

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RATE APPEALS: ANOTHER ROAD TO MEDICAID GOLD?

In a recent case in New York State Court, "23 residential health care facilities" (read:  nursing homes) challenged the rates they were paid for rendering services to Medicaid patients.  Collectively, they had previously filed over 160 rate appeals, the court said.

          True it is that nursing homes are entitled by law to be reimbursed for the services they provide to Medicaid recipients.  It is also true that under the Medicaid program, these providers of services covered by Medicaid are given an "administrative review procedure to review and challenge" the amount of Medicaid money they receive for their services.

          During the current Sunshine Week, in which all things are made visible, it is a good thing to shine a light on rate appeals of Medicaid money.  "Trust but verify," which I understand comes from a Russian proverb.  A good proverb for cases like this recent case in New York State Court:  Woodside Manor Nursing Home, Inc. v. Zucker, 223 A.D.3d 94, 204 N.Y.S.3d 256 (N.Y. App. Div. 3d Dep't 2024).

Significant features of the Medicaid Program like the rate appeals involved in the Zucker case in New York, are the subject of Chapter 18D, titled Medicaid and the Children's Health Insurance Program (CHIP), in Volume 2 of CATASTROPHE CLAIMS / INSURANCE COVERAGE FOR NATURAL AND MAN-MADE DISASTERS (Thomson Reuters Nov. 2023 edition, 2024 Supplement in process).

Please read the disclaimer.  ©2024 Dennis J. Wall.  All rights reserved.

MEDICAID EXPANSION IN MISSOURI: EQUAL PROTECTION FROM & OF THE VOTERS.

In Doyle v. Tidball, ___ S.W.3d ___, No. SC 99185, 2021 WL 3119116 (Mo. July 22, 2012), the Missouri Supreme Court unanimously held that the effect of the plain language of the voters' State Constitutional Amendment requires equal protection if the Missouri Legislature appropriates any money for Medicaid (as it must under other requirements of law).

          The Missouri State Constitution Medicaid Expansion Amendment extends the eligibility of Medicaid in Missouri.  It does not affect the appropriation of funds, the Court ruled.

          However, the funds that have been appropriated (so far) by the Missouri Legislature are intended to be applied equally -- even if the funds appropriated are inadequate to the task.

          The Court ruled that "the plain language of the purposes stated [in the appropriations bills is] to fund MO HealthNet without distinguishing between benefits provided to individuals who are eligible as part of the pre-expansion population and those eligible only under article IV, section 36(c) [the Missouri State Constitution Medicaid Expansion Amendment]."  Doyle v. Tidball, 2021 WL 3119116, at *6.

          That's how Medicaid Expansion was upheld in Missouri:  The Missouri Supreme Court rejected any notion that the Missouri Legislature attempt to impose inequality in health care in a pandemic.

          That's the rest of the -- real -- story here.  Much has been written about the Missouri Supreme Court's decision in the popular press, but I have not seen this published anywhere else as yet.

Please read the disclaimer.  ©2021 Dennis J. Wall.  All rights reserved.

WHERE BREACH OF CONTRACT MEETS IMPLIED COVENANT OF GOOD FAITH.

In Colwell v. MCNA Ins. Co., 960 N.W.2d 675 (Iowa 2021) (emphasis in original), the unlabeled synopsis at the outset of the published decision, printed even above the identification of the Justice who wrote the opinion for the Court, states:

The defendants appeal the district court's ruling in favor of the plaintiff finding breach of contract and breach of implied covenant of good faith and fair dealing. AFFIRMED.

         The Iowa Supreme Court's opinion refers only to the breach of contract conduct, so far as I can find from reading the opinion.  When the Supreme Court unanimously affirmed the trial court's bench-trial judgment for the plaintiff on the plaintiff's breach of contract claim, necessarily they also unanimously affirmed the trial court's judgment for the plaintiff on the plaintiff's claim for breach of the implied covenant of good faith and fair dealing.

          Judgment was entered by the trial court on both claims, it appears.  Therefore, an appeal from that judgment was an appeal from judgment for the plaintiff on both claims, and so the Supreme Court's affirmance of the trial court's judgment was an affirmance of judgment for the plaintiff on both claims.

          Apparently in some cases at least, breach of the implied covenant and breach of contract can result in a judgment on both claims, such that appealing the judgment decides the appellate fate of not one but both of the claims.

Please read the disclaimer.  ©2021 Dennis J. Wall.  All rights reserved.