The requirement of Soc. Sec. Act §1902(a)(8) that states allow all individuals an opportunity to apply for medical assistance the opportunity to do so and to "furnish assistance with reasonable promptness to all eligible individuals" does not impose any obligation on the states to provide or arrange for actual services because Soc. Sec. Act §1905(a) defines medical assistance as payment of part or all of the cost of covered services. Therefore, a class of individuals with mental retardation who had been found eligible for home and community-based waiver services (HCBS) and placed on a waiting list had no right to the services unless a slot in the waiver program was open. The subclasses whose claims were denied without notice and an opportunity for a hearing or who never received any decision on their applications, however, could seek enforcement of these rights created by Soc. Sec. Act §1902(a)(3) and (a)(8). The claims against the state Department of Mental Health and Mental Retardation were dismissed due to the Eleventh Amendment bar to suits against the state, and claims seeking enforcement of state law were dismissed for lack of jurisdiction. The state officials could be held liable individually in a civil rights action and ordered to comply with federal law. The state's placement of named plaintiffs in waiver slots close to the scheduled trial date did not eliminate jurisdiction of their claims if the individuals remained on waiting lists for other requested services because the agency might treat them the same way on their remaining requests. The claims of individuals who were no longer seeking services were dismissed as moot.
Susan J. v. Riley, M.D. Ala., April 29, 2009.
For more information on this and related topics, consult the CCH® Medicare and Medicaid Guide.
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