A person in New Jersey in need of nursing home care, they may be relying on Medicaid to help finance the care they need. However, it is the unfortunate fact that sometimes a person’s initial application for Medicaid is denied, even if they have spent the time to try to develop a strong Medicaid planning strategy. This can be incredibly discouraging, but it does not have to be the end of the story. This is because it is possible to appeal a denied claim for Medicaid benefits.
A Medicaid appeal begins with the filing of the appeal with the New Jersey Division of Medical Assistance and Health Services (DMAHS). Following that the person pursuing the appeal will have a hearing with an administrative law judge (ALJ). At this hearing, the person can be represented by an attorney.
The judge will issue a recommendation which will then go to the DMAHS director for a final decision. The DMAHS may approve the denied claim, and the person pursuing the claim will obtain the Medicaid benefits they need. However, if the DMAHS denies the claim, the appeals process continues. Sometimes the next step of an appeal is to bring one’s case to the New Jersey Superior Court. However, it could be well over a year before a person’s appeal will be heard in court.
However, there is another option. If a person’s claim for Medicaid benefits is denied by the DMAHS following a hearing with an ALJ, it may be possible under some circumstances to instead file an appeal with the federal court. In this situation, a person may only have to wait approximately six months for a person to have their claim heard in court and for the court to issue its decision.
At our firm, we understand that appealing a denied Medicaid claim can be a daunting task. We have represented clients in such situations, providing them with the legal advice and representation they need to present their case to an ALJ and in court if necessary. Our webpage on Medicaid in New Jersey may be of use to those who are looking for information on appealing a denied claim for benefits.