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Nursing Home Need Not Keep Resident Until Medicaid Appeals Are Exhausted – King v. Butler Rest Home et al.

As a Pennsylvania nursing home lawyer, I was interested to see an appeals court decision in Kentucky that could spell bad news for patients fighting for Medicare funding. In King v. Butler Rest Home et al., Geneva King and her family were fighting to keep her in the River Valley Nursing Home while she appeals decisions denying her Medicaid funding to pay for the home. King had been a private-pay client before applying, but was denied twice before filing appeals. While those appeals were pending, the home attempted to discharge King for nonpayment. In this decision, the Kentucky Court of Appeals found that King and other potential Medicaid recipients are not entitled to stay in nursing homes until their appeals are exhausted.

King stopped making payments to River Valley in June of 2009, as part of applying for Medicaid. She applied twice and was denied both times, then appealed. That appeal was pending in February of 2010, when the home informed her daughter and legal representative, Diana Livengood, that King would be discharged for nonpayment. King then filed an appeal of the discharge with the Kentucky Cabinet for Health and Family Services. That appeal was denied, and King then appealed to state court, which issued a temporary injunction stopping the discharge while it reviewed the Cabinet’s decision. After affirming that decision, the court lifted its injunction, giving rise to the current appeal.

On appeal, King first argued that the Cabinet was wrong to rule that River Valley could not discharge her before there was a final ruling on the Medicaid appeal. Under Kentucky law, nonpayment is explicitly named as one of the reasons nursing home patients may be discharged. King pointed to rules from the Centers for Medicare and Medicaid Services, which say residents cannot be transferred for nonpayment unless their claims have been denied — but the court said Medicare payment had already been denied. It declined to agree that a claim is not denied unless an appeal is exhausted. It also disagreed that notice should have gone to King rather than to Livengood, since Livengood was King’s legal administrator. Finally, the appeals court ruled that River Valley did not prepare King insufficiently for the transfer, because it followed its normal discharge procedure of preparing the home a week in advance. Thus, King’s appeal of her discharge was denied.

This situation is disappointing to me as a Philadelphia injury lawyer. Nursing home patients are generally in the homes because their health problems make it hard for family members to take care of them. This makes them hard to move; they frequently also do not want to be moved. If King’s Medicaid appeal succeeds, she will later have to move back to River Valley or another home, disturbing her further in what was ultimately an unnecessary pair of moves. And of course, Livengood may not be well equipped financially and personally to handle having an elderly mother with health problems in her home full time. Of course, businesses need to be paid, but as a Philadelphia medical malpractice lawyer, I’m disappointed that the needs of this patient did not come first.

Rosenbaum & Associates represents people throughout Philadelphia and all of Pennsylvania who were seriously hurt or lost a loved one in an abusive or neglectful nursing home. For a free, confidential case evaluation, send us an email or call 1-800-7-LEGAL-7.

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