State Medicaid Agency Lacked Jurisdiction to Hold Hearing on Involuntary Discharge Outside of Mandatory Time Limits

An Illinois appeals court rules that the failure of the state’s Department of Public Health to hold a hearing on a Medicaid denial within 10 days of a nursing home’s request to involuntarily discharge a resident rendered the agency’s decision void. Lakewood Nursing and Rehabilitation Center, LLC v. Dept. of Public Health (Ill. App., 3rd Dist., No. 3-17-0177, Aug. 16, 2018).

On October 20, 2013, Lakewood Nursing and Rehabilitation Center notified resident Helen Sauvageau that it intended to discharge her for failure to pay. Through her attorney, Ms. Sauvageau filed an application for Medicaid benefits, and the parties agreed to stay a pending request for a hearing before the Illinois Department of Public Health until Medicaid made its decision. Subsequently, Medicaid denied Ms. Sauvageau’s application, and on January 15, 2014 Lakewood requested a discharge hearing before the Department.

On February 10, 2014, during a preliminary hearing, Lakewood filed a motion to dismiss its request for a hearing, asserting that the Department had lost jurisdiction to hear the matter because it was outside of the statutory time requirement that hearings be held "not later than 10 days" after being requested. Ms. Sauvageau countered that she was appealing the Medicaid denial and that failing to hold a hearing would violate her due process rights. The Department denied Lakewood’s motion to dismiss, concluding that the time limits in the statute were directory rather than mandatory and that strict compliance with them would cause more harm than a delay. Following a hearing held on March 24, 2014, the Department entered a final order approving the involuntary discharge. Lakewood appealed the Department’s decision to a trial court, and the trial court agreed with the Department Lakewood appealed again.

The Appellate Court of Illinois, Third District, reverses the trial court, finding that the term "not later than 10 days" in the statute constitutes negative language that requires a mandatory interpretation of the statute. The court rules that the Department lost jurisdiction because the hearing was held 68 days after Lakewood made the request.

For the full text of this decision, go to: https://www.illinoiscourts.gov/Opinions/AppellateCourt/2018/3rdDistrict/3170177.pdf

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