LAWSUITS NEWS & LEGAL INFORMATION
Payments Begin in Landmark $16 Million Medicaid Class Action
Washington, DC: In two cases that will have far-reaching implications for the way the Medicaid program is administered, Washington, DC and Maryland have begun to make comprehensive changes in the way they administer payments for nursing home residents-a major sector of the Medicaid program.
The two cases are Janigian v. District of Columbia (in the District) and E. Smith, et al. v. John Colmers, et al. (in Maryland). Both alleged violations of federal and state law by overcharging Medicaid recipients for co-payments for their nursing home care, and they were the first such lawsuits brought in the United States.
The agreements affect residents who are in debt to nursing homes when they qualify for Medicaid. Federal law requires that residents' Medicaid co-payments be reduced by the amount of that debt so that residents will have income available to pay their nursing home for pre-Medicaid services. Under their old rules, the District and Maryland ignored that law and set individual co-payments without regard to nursing home debt, leaving residents with no money to pay pre-Medicaid nursing home bills. Under the new agreements, the District and Maryland must comply with federal law and reduce the residents' co-payments so that they can use some of their income to pay the old debts. Medicaid will cover the entire cost of nursing home care until those old debts are paid off.
Maryland has also agreed to pay $16 million over three years in adjusted Medicaid reimbursement claims, half of which will be reimbursed by the federal government. In return for the payments, which began today, up to $64 million in unpaid nursing home charges owed by Medicaid recipients will be forgiven by nursing homes. In addition, both the Smith and Janigian cases have already resulted in modifications to the way the District and Maryland calculate recipients' co-payments on an ongoing basis. The agreements were approved by the Washington, DC and Maryland courts earlier this year.
Published on Aug-18-10
The two cases are Janigian v. District of Columbia (in the District) and E. Smith, et al. v. John Colmers, et al. (in Maryland). Both alleged violations of federal and state law by overcharging Medicaid recipients for co-payments for their nursing home care, and they were the first such lawsuits brought in the United States.
The agreements affect residents who are in debt to nursing homes when they qualify for Medicaid. Federal law requires that residents' Medicaid co-payments be reduced by the amount of that debt so that residents will have income available to pay their nursing home for pre-Medicaid services. Under their old rules, the District and Maryland ignored that law and set individual co-payments without regard to nursing home debt, leaving residents with no money to pay pre-Medicaid nursing home bills. Under the new agreements, the District and Maryland must comply with federal law and reduce the residents' co-payments so that they can use some of their income to pay the old debts. Medicaid will cover the entire cost of nursing home care until those old debts are paid off.
Maryland has also agreed to pay $16 million over three years in adjusted Medicaid reimbursement claims, half of which will be reimbursed by the federal government. In return for the payments, which began today, up to $64 million in unpaid nursing home charges owed by Medicaid recipients will be forgiven by nursing homes. In addition, both the Smith and Janigian cases have already resulted in modifications to the way the District and Maryland calculate recipients' co-payments on an ongoing basis. The agreements were approved by the Washington, DC and Maryland courts earlier this year.
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READER COMMENTS
David Manuel
on
insurance claim benefit payment for all of the health, medical, and miscellaneous services that were covered by my health insurance plan called
Med-Cal/CalOptima/Arta Western Health Network.
I am a resident in the State of California in which I am insured in the Medi-Cal Program. Medi-Cal is the State of California's health/medical insurance
which was issued to me by the California Depart-ment of Health Care Services and managed by the California Department of Managed Health Care(Health Maintenance Organization or HMO).
I am co-insured by CalOptima which is a public agency located in the city of Orange, California and is Orange County's health insurance agency
in the Medi-Cal Program. I am also insured by Arta Western Medical Group a healthcare agency
located in the city of Costa Mesa, California. Get-
ting back about my problem, I have not been paid my health insurance claim benefit payment by my insurers. I am supposed to be paid my daily bene-fit payment for all of the health, medical and other services including my daily hospitalization stay in hospitals and nursing home care facilities that were covered by my health insurance plan. I am
paid my benefit payment in this health insurance program based on the computation of my in-comes multiplied by the Cost of Living Adjustment Rate which is currently 1.003% which my daily benefit amount must be between the minimum
daily benefit amount that is $50 up to the maxi-mum daily benefit amount that is $260. I would like for you to send me information of any class action lawsuits about health insurance claims and
also information if whether I could possibly file a claim under a class action lawsuit precedent case.
Give me a reply very soon.