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In a recent decision that underscores the complexities of challenging state Medicaid decisions in federal court, the Eighth Circuit Court of Appeals affirmed the dismissal of a lawsuit alleging due process violations in Nebraska's Medicaid termination process. The case, Filyaw v. Corsi, 150 F.4th 936 (8th Cir. Aug. 27, 2025), highlights critical barriers posed by the Eleventh Amendment and serves as a reminder for seniors and their families about the importance of timely action when facing benefit terminations. For those relying on Medicaid, understanding these procedural hurdles is vital to protecting access to services.Case Background
Gillian Filyaw, a Nebraska resident, began receiving Medicaid benefits in 2020. Medicaid, a joint federal-state program, provides health coverage to low-income individuals, including many older adults who rely on it for long-term services and supports (LTSS) to remain in their homes rather than entering nursing facilities.
In April 2024, Filyaw received a notice from the Nebraska Department of Health and Human Services (NDHHS) informing her that she was no longer eligible for coverage because her income exceeded the program's standards. The notice outlined her appeal rights: she could request a fair hearing within 90 days, and if she appealed within 10 days, NDHHS would refrain from taking adverse action until a decision was rendered. Unfortunately, Filyaw did not file an appeal, and her coverage terminated in May 2024.
Two months later, in June 2024, Filyaw filed a federal lawsuit under 42 U.S.C. § 1983 against NDHHS officials in their official capacities. She sought to represent herself and a proposed class of current and future Nebraskans who had received or would receive similar termination notices based on income ineligibility. The complaint alleged that the NDHHS notice violated constitutional due process requirements under the Fourteenth Amendment by failing to adequately explain the reasons for termination or provide sufficient information for beneficiaries to contest the decision effectively.
Filyaw requested class certification, a declaratory judgment that the notice was unconstitutional, and injunctive relief to reinstate her benefits, and those of the class, until a constitutionally compliant notice was issued. The district court granted NDHHS's motion to dismiss, citing sovereign immunity, and Filyaw appealed.The Eighth Circuit's Reasoning
The appellate court focused primarily on the Eleventh Amendment to the U.S. Constitution, which generally bars suits against unconsenting states in federal court, whether brought by their own citizens or those from other states. An exception, established in Ex parte Young (1908), allows suits for prospective injunctive and declaratory relief against state officials in their official capacities if they are alleged to be engaging in an ongoing violation of federal law. However, this exception is narrow: plaintiffs must demonstrate an active, continuing infringement, not merely the lingering effects of a past wrong.
In what the court described as a case of first impression, it held that Filyaw failed to allege an ongoing violation. The purported due process breach, the inadequate notice, was a "discrete" and "completed" act that occurred when she received it in April 2024. While she experienced the consequences (loss of benefits) afterward, this did not constitute a recurring violation. The court emphasized: "The only alleged violation of federal law was the discrete violation that occurred when [Filyaw] received the notice—a completed act that was not repeated."
Furthermore, Filyaw's claims of future harm were deemed speculative. She argued that she faced an imminent risk of receiving the same deficient notice if she reapplied for Medicaid. But the court rejected this, noting she was no longer enrolled and had not alleged facts showing she would likely become eligible again soon. Without a "real likelihood" of future violation, her suit did not fit the Ex parte Young framework.
The relief sought was also characterized as retrospective rather than prospective. Reinstatement of benefits would compensate for a past error, which sovereign immunity prohibits. Declaratory relief similarly failed, as it would amount to a judgment that state officials had violated federal law in the past, without addressing an ongoing issue. As the court put it, the exception does not permit "a judgment against a state official declaring that they had engaged in a past violation of federal law."
The decision was unanimous, with no dissenting opinions noted.Implications for Elder Law and Aging in Place
This ruling has significant ramifications for elder law practitioners and individuals relying on Medicaid for aging in place. Many seniors rely on Medicaid to cover home health aides, adult day care, or modifications like grab bars and ramps—services that enable independent living and avoid costly institutionalization. However, eligibility can fluctuate due to income changes, asset transfers, or other factors common in estate planning. For an article on this Blog outlining how Medicaid might be used to age in place, go here.Due Process in Medicaid Notices
Federal regulations under 42 C.F.R. § 431.210 require pre-termination notices to include clear reasons for the action, supporting facts, and appeal rights. Filyaw illustrates how courts may scrutinize not just the content of notices but the timing and nature of challenges. Had Filyaw appealed within the 10-day window, her benefits might have continued pending a hearing, potentially avoiding the loss altogether. This case reinforces the need for prompt action: beneficiaries should immediately consult an elder law attorney upon receiving a termination notice to evaluate appeal options and ensure due process compliance.Sovereign Immunity Barriers
The decision limits federal court challenges to state Medicaid practices unless an "ongoing" violation is clearly alleged. For class actions, this could make it harder to seek systemic reforms, such as improved notice templates, without showing continuous harm. Plaintiffs might need to frame complaints around current enrollees facing imminent terminations rather than past recipients like Filyaw.In estate planning contexts, this underscores the value of proactive strategies. Tools like irrevocable trusts can help protect assets while maintaining Medicaid eligibility, but they require careful timing to avoid penalties. Families should monitor income thresholds and plan for potential redeterminations, especially post-COVID unwinding periods when many states, including Nebraska, resumed eligibility reviews.Broader Policy Considerations
While Filyaw is binding only in the Eighth Circuit (Arkansas, Iowa, Minnesota, Missouri, Nebraska, North Dakota, South Dakota), it may influence other jurisdictions. Advocates for older adults argue that inadequate notices disproportionately affect vulnerable populations, including those with cognitive impairments who may struggle to navigate appeals. This case could spur state-level reforms or federal guidance to enhance notice clarity, aligning with broader goals of supporting aging in place.Takeaways and Recommendations
- Act Quickly on Notices: Don't delay appeals—request a fair hearing within the shortest timeframe to preserve benefits.
- Seek Professional Guidance: Elder law attorneys can review notices for due process issues and assist with reapplications or asset protection plans.
- Plan Ahead: Incorporate Medicaid planning into your estate strategy, using trusts and other tools to safeguard eligibility for home-based care.
- Stay Informed: Monitor changes in Medicaid rules, as states continue to adapt post-pandemic.
This decision reminds us that while Medicaid is a lifeline for aging in place, navigating its administrative maze requires vigilance and expertise. If you're facing a similar situation, contact a qualified elder law professional to explore your options.
