December 3, 2018

A New York appeals court holds that a Medicaid recipient is not entitled to reimbursement for out-of-pocket payments to home health aides made before the recipient became eligible because there was no erroneous denial of Medicaid eligibility or delay in determining eligibility. In the Matter of Dell’Olio v New York State Office of Temporary and Disability Assistance (N.Y. Sup. Ct., App. Div, 2nd Dept., No. 2017-00224, Nov. 7, 2018).

Felicia Dell’Olio’s husband suffered from Parkinson’s disease, so she hired two home health aides to care for him and she paid for them out of pocket. In 2013, Mr. Dell’Olio began receiving Medicaid benefits. In March 2014, Mr. Dell’Olio applied for a Medicaid program that would allow him to continue to use the same home health aides by paying them through an intermediary. The state approved the application in May 2014. Mr. Dell’Olio requested reimbursement for out-of-pocket expenses paid from January 2014 to May 2014.

The state denied the request for reimbursement because the home health aides did not participate in the Medicaid program. The trial court annulled the state’s decision and approved the reimbursement. The state appealed.

The New York Supreme Court, Appellate Division, Second Department, vacates the trial court’s decision, holding that Mr. Dell’Olio is not entitled to reimbursement. According to the court, the state may only “directly reimburse individuals who make out-of-pocket payments for covered services if it erroneously denies an individual’s application for coverage or delays in determining eligibility.”

For the full text of this decision, go to: https://iapps.courts.state.ny.us/search/wicket/page?5-IResourceListener-pnlResult-7-lnkDocument