Medicaid Appeals Can Be Necessary For Some
If your Medicaid application is denied, you have the right to appeal (a fair hearing).
A Medicaid appeal of a denial is filed with the state Division of Medical Assistance and Health Services (DMAHS) and the denied applicant, alone or with an attorney, appears before 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 DMAHS policies 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” does it; but it is current New Jersey law.
Given this fact, someone appealing a fair hearing must present firm legal arguments as to why the denial of the initial application was incorrect since no discretion/sympathy will be forthcoming in the final decision of the DMAHS director. A Medicaid appeal is not for a lay person or a legal novice. If you file the original application as a “do it yourself” and it is denied, then our practice policy is that you must pursue the appeal/fair hearing on your own. It is far less expensive to have competent certified elder law attorneys (CELAs) file the initial application. Do it right the first time.