NY Health Access About Us   |   Contact Us Empire Justice Center Legal Aid Society NYLAG WNYLC

Delays in Processing of Medicaid Applications - What are Your Rights and Lawsuits Challenging Delays

print  Print
share  Share
Views: 20643
Posted: 23 Aug, 2012
by Valerie Bogart (New York Legal Assistance Group)
Updated: 25 Aug, 2019
by Valerie Bogart (New York Legal Assistance Group)

The Deadlines to Process Medicaid Applications in the Law

Federal and state law set time limits for processing a Medicaid application.  The federal Medicaid Act requires eligibility to be determined with "reasonable promptness."  A determination of eligibility for Medicaid must generally be made within a 45-day time period, with two exceptions. 

  • Determinations of eligibility for pregnant women and children under age 19 must be completed  within 30 days. 

  • Cases awaiting a disability determination have a 90-day time limit.  If the eligibility determination process for determining disability takes more than 90 days, on or before the 90th day, the applicant should be sent a written  statement stating the reasons for the delay.  When the applicant is eligible under a different category, Medicaid is authorized for the  interim period.   This 90-day limit applies to applicants who submit a supplemental needs trust or pooled trust with the application, if the approval of the trust requires a determination that they are "disabled," and either they are age 65+ or are under 65 and have not been determined "disabled" by the Social Security Administration. 

42 USC Sec 1396a(a)(8); 42 C.F.R. Sec. 435.911; 18 NYCRR 360-2.4NYS Medicaid Reference Guide pp. 487-488;

See also 10ADM-04 - Elimination of the Personal Interview Requirement for Medicaid and Family Health Plus Applicants 

The Reality:  Delays Trigger Litigation

Despite the clear time limits in law and regulation, many local districts take much longer time to process Medicaid applications.  Various lawsuits have been filed over the years seeking to enforce compliance with the federally mandated time limits. Information about some of the lawsuits in NYS can be found at the links below.   The links include contact information for plaintiffs' counsel. 

New York City

Garcia v. Banks,  Settlement and Order, Mar. 12, 2019 (16-CV-08370)(SDNY).  Effective around May 2019, requires HRA to render Medicaid eligibility determinations within 90 days for people applying based on disability. This includes applications submitted with a pooled or individual SNT for an individual age 65+, since the approval of the trust requires a determination that the applicant is "disabled" as defined by law.  It also includes individuals under age 65 who claim to be disabled, but for whom the SSA has not yet determined that they are disabled, if the individual is not otherwise eligible through MAGI Medicaid (Affordable Care Act) or another pathway.  HRA commits to eliminating systemic blockages in its system by maintaining a new computer tracking system that will assist HRA in identifying and prioritizing older applications. Settlement. at 5-6, § II(B).   The Class does not include persons who apply for immediate needs personal care services, for which HRA must make a determination within 7 days.

Reynolds v. Giuliani, 35 F. Supp. 2d 331 (S.D.N.Y.1999), modified on other grounds, 43 F. Supp.2d 492 (S.D.N.Y. 1999) (not specifically addressing application delay processing, but NYC’s failure to permit prospective applicants to file their applications for FS, MA, and PA on the first day they visit a NYC Job Center and the failure to do separate MA and FS determinations for those applicants whose PA application is denied or withdrawn).

Suffolk County

Contempt Motion Responds to Suffolk County’s Failure to Provide Promised Food and Medical Assistance Promptly (February 2012)(Maryann v. DeMarzo, Doe v. Blass)

Nassau County

NCLEJ and Colleagues Secure Settlement with Nassau County, NY, to Speed Provision of Food Stamps, Medicaid, and Cash Public Assistance (June 2011)(Dowdell v. Imhof)

NCLEJ Sues Nassau County NY For Delaying Food Stamps, Medicaid, and Cash Public Assistance to Hundreds Each Month(April 2010)

Columbia County

NCLEJ and Colleagues Sue Columbia County, NY for Systemic Failure to Process Food Stamp, Medicaid, and Cash Assistance Applications in a Timely Fashion (June 2011)(Travis v. Mossman)

Steuben County

Steuben County, NY Agrees to Speed Up Issuance of Food Stamps, Medicaid Assistance, and Cash Public Assistance to those Hard Hit by Recession (November 2009)(Kari C. v Mullen)

NCLEJ, Western New York Law Center, and Empire Justice Center file class action challenging food stamp, Medicaid, and cash public assistance application delays in Steuben County, NY (July 2009)

Erie County

Martin v. Weiner (W.D.N.Y. 2008 settlement)

Attached files
item Settlement Agreement - Garcia.pdf (762 kb) Download

Also read
item Advocate's Outline on Supplemental Needs Trusts and Rules for Impact of Lump Sums on Various Benefits
item How to use a pooled SNT to eliminate the Medicaid spend-down.
item When Documentation of Resources and Income is Required for Medicaid Applications & Renewals - and When is "Attestation" Enough?
item Step-by-step guide to enrolling in a pooled income trust for Medicaid spend-down
item Where to Apply for Medicaid and Medicaid Home Care in New York City
item NYS Medicaid Application Form (updated 2021) for Age 65+ or Disabled or Blind - New Supp A NYC 2021
item Medicaid Disability Determinations - NYS Forms & Procedures (with updated forms Dec. 2021)
item "MAGI" Medicaid Eligibility under the Affordable Care Act - Rules for Most People Under age 65 Without Medicare
item "Immediate Need" Fast-Track Application for Medicaid and Personal Care or CDPAP - Choices for those with full Medicaid start April 2024

Also listed in
folder Medicaid -> Applying For and Keeping Medicaid

Prev     Next
Tools for Choosing a Medicaid Managed Long Term Care Plan       Grievance and Appeal Contacts for Managed Long Term Care Plans

This site provides general information only. This is not legal advice. You can only obtain legal advice from a lawyer. In addition, your use of this site does not create an attorney-client relationship. To contact a lawyer, visit http://lawhelpny.org. We make every effort to keep these materials and links up-to-date and in accordance with New York City, New York state and federal law. However, we do not guarantee the accuracy of this information. To report a dead link or other website-related problem, please e-mail us.