COMPLAINT FOR SUPERINTENDING CONTROL
Oct 10, 2011OUTCOME: DHS Approved the Medicaid Application without further litigation
Plaintiff, Medicaid applicant, and her daughter, authorized representative, by and through their attorneys, Rygiel Sprague P.C. states for its Complaint as follows; Plaintiff was been a patient in ... a Macomb County Medicaid facility known as ********* Nursing Center, located *********** Sterling Heights, MI 48310 (the “Nursing Facility”) at all relevant times pertinent to the claim for Medicaid payment of Nursing Facility long term care costs. Defendant, Michigan Department of Human Services (“DHS”) is a state administrative agency charged with administering the Medicaid Program, a program that provides for basic health care coverage for those who meet its personal and financial eligibility requirements. Plaintiff applied for Medicaid properly seeking Nursing Facility benefits retroactive to April 1, 2011 through a hand-delivered Medicaid Application (the “Application”) to the local office of DHS located at 21885 Dunham Road, Clinton Township, MI 48036 on April 27, 2011 (See Medicaid Application attached as Exhibit 1). Plaintiff meets the criteria for Medicaid eligibility. Michigan’s Medicaid program is administered by county based local offices, pursuant to federal and state statutes, federal and state regulations, and pursuant to policy issued by DHS that all local offices are required to follow. DHS policy requires that a local office issue such determinations within 45 days of receipt of an application. Plaintiff requests that this honorable Court grant the following relief: A. Enter a Superintending Control Order directing the Michigan Department of Human Services to immediately (i.e. within seven (7) days of the date of this Order) process and issue a decision on Plaintiff’s Medicaid Application; B. Award costs and fees, including attorney fees to Plaintiff which were so wrongfully sustained in order to compel Defendant DHS to follow its own rules and policies; and C. Order such other relief as the Court deems appropriate and just.
