A U.S. District Court in Ohio has ruled that the state must cover assisted living services up to three months before the month of a Medicaid beneficiary’s application to an assisted living community. The case is believed to be the first to use Medicaid’s retroactivity requirement to challenge federal long-term services and supports payment policies, reports the American Network of Community Options and Resources.
The case was brought by a plaintiff who had incurred thousands of dollars of debt for assisted living services provided after application to the community and before the date on which the Ohio Medicaid program formally approved the service plan. The court ruled that the services could be provided pursuant to a service plan, even if those service plans were approved after the provision of services, if the services were consistent with the service plan. Current Medicaid procedures improperly incentivize nursing home care over home- and community-based services, according to the court.
The decision’s reasoning applies to HCBS programs across the country, whether those HCBS programs cover assisted living or in-home services, ANCOR says.