Medicaid Appeals

Call 973-577-6010 For a Free Initial Consultation

If a Medicaid application is denied, there is a right to appeal the denial (a Fair Hearing).

A Medicaid Appeal is filed with the state Medicaid agency (DMAHS) and the denied applicant, alone or with their attorney, is heard by an Administrative Law Judge (ALJ), whose decision is only a recommendation for final decision filed with the Director of DMAHS. Should the Director affirm the denial, the client must then file another appeal in the Appellate Division of the New Jersey Superior Court and wait approximately 1½ years before the case is heard.

But, wait a minute, aren't the policies of DMAHS the reason the application was denied in the first instance? The answer is "yes" and under New Jersey Administrative Law, the Director of DMAHS makes the final decision on the original denial. Doesn't sound like a "Fair Hearing," but it is the current New Jersey law.

Given this fact, the decision to appeal to a Fair Hearing must present firm legal arguments why the denial was incorrect since no discretion/sympathy will be forthcoming from the final decision of the DMAHS Director. A Medicaid appeal is not for a lay person or a legal novice. If you try the original application "on your own" and it is denied, then our practice policy is to have you pursue the appeal/Fair Hearing "on your own." It is for less expensive to have competent CELA representatives on the initial application.

For a free initial consultation regarding NJ Medicaid Appeals, call us at 973-887-4254 or click here to contact us online.