The M.A. lawsuit was filed in 2015 on behalf of both waiver and non-waiver Medicaid-eligible children under the age of 21 in Illinois receiving in-home skilled nursing care. Plaintiffs alleged the processes and notices for determinations of medical necessity of in-home skilled nursing care violated the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) requirement of the Medicaid statute (through Section 1983), the community-integration mandate of the Americans with Disabilities Act (as interpreted in Olmstead v. L.C.), and the Rehabilitation Act.
On May 4, 2016, the United States District Court for the Northern District of Illinois certified the case as a class action for the following individuals: “All Medicaid-enrolled children under the age of 21 in the State of Illinois, including children who are enrolled in a Medicaid waiver program, who received in-home shift nursing services or applied for in-home shift nursing services and received notices from the Illinois Department of Healthcare and Family Services that their requests for in-home shift nursing services had been denied, or reduced, or approved at a lower level than requested, or terminated by the Illinois Department of Healthcare and Family Services on or after January 1, 2014.”
The parties agreed to resolve the M.A. class action through a Settlement Agreement that was approved by the Court on December 19, 2018. The Settlement Agreement requires the Department to revise existing processes for reviewing medical necessity and granting prior approval for in-home shift nursing services. For more information on the M.A. Settlement Agreement, please see the documents available below.
M.A. Settlement Agreement Documents