Authorized Representatives Cannot Sue State on Behalf of Medicaid Beneficiaries

The Seventh Circuit rules that Medicaid regulations do not permit authorized representatives to bring civil lawsuits on behalf of Medicaid beneficiaries. Bria Health Services, LLC v. Eagleson (U.S. Ct. App., 7th Cir., No. 18?3076, Feb. 11, 2020).

Nursing home residents in Illinois signed forms designating nursing home consultants as their authorized Medicaid representatives. Medicaid regulations permit Medicaid beneficiaries to name authorized representatives to sign a Medicaid application, complete a renewal form, receive copies of notifications, and act on the beneficiary’s behalf in all other matters with the agency.

The consultants sued the state under Medicaid law, claiming the state failed to timely process claims for payment submitted by the nursing homes. The consultants argued that this constituted a failure to provide medical assistance. The state filed a motion to dismiss for lack of subject matter jurisdiction, which the district court granted, holding that the consultants did not have standing. The consultants appealed, arguing that they were acting on behalf of the Medicaid beneficiaries.

The U.S. Court of Appeals for the Seventh Circuit affirms, holding that Medicaid regulations do not permit authorized representatives to bring civil lawsuits on behalf of Medicaid beneficiaries. According to the court, “the regulation is limited to communication with the agency,” and does not “extend to litigation against it.” The court notes that if a Medicaid beneficiary lacks capacity to sue, “a guardian or next friend” may sue on his or her behalf.

For the full text of this decision, go to: http://media.ca7.uscourts.gov/cgi-bin/rssExec.pl?Submit=Display&Path=Y2020/D02-11/C:18-3076:J:Hamilton:aut:T:fnOp:N:2471526:S:0

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