Medicaid eligibility requires a review of assets and spending for a period of five years prior to qualifying for benefits. It is important that families consider loss of Medicaid benefits when managing assets and expenditures. Such Medicaid planning is a routine service for an Elder Law attorney.
To apply for Medicaid, a detailed application must be submitted. Obtaining necessary records can become burdensome and cause delays, especially on behalf of an incapacitated applicant. An attorney can also help with the Medicaid application process.
Medicaid Appeals in New Jersey
If your county Social Services Department denies your application, you have a right to appeal. An appeal is filed by requesting a “Fair Hearing”. You must file it within twenty days of its receipt or the denial will be permanent. Appeals may also be filed if you believe the terms of the benefit award are wrong. For example, if you believe benefits should start in January, but Social Services finds they should start in March, you can appeal. You may also request a Fair Hearing if you believe that Social Services has taken too long to process your application for benefits, assuming many months have passed without comment by that office.
New Jersey Medicaid Appeals Process
The Fair Hearing process begins with the filing of a request form. This is filed with the Fair Hearing Unit of the NJ Division of Medical and Health Services (DMAHS). Once this is done, the Unit will set a date and place for the hearing.
The hearing will be heard by an Administrative Law Judge, or “ALJ”. It is a trial, and both sides will be able to present evidence. It is essential that arguments of law based upon the Medicaid regulations are made. Professional legal representation is strongly recommended. Once the hearing is completed, the ALJ will have time to write the decision, which will be distributed to all parties.
The ALJ’s decision is then sent to the DMAHS Director for approval or reversal. Many times, it is approved. When it is reversed, you may appeal to the NJ Appellate Division, or, in some circumstances, in Federal Court.
Timing of Appeals?
From requesting the hearing to the written decision, a minimum of four months can be expected. It could take longer, particularly if a party requests an adjournment. Remember that the Fair Hearing still means that the Medicaid Application is pending. Nursing homes may not discharge a resident while a Medicaid application or appeal is pending, despite not getting fully paid.
Help is Available
An experienced New Jersey elder law attorney advises regarding Medicaid planning, prepares applications, and, if necessary, files an appeal. It is important that families consult with an attorney as soon as the potential, future need for Medicaid assistance is known. This ideally occurs during the estate and asset planning process, years prior to filing a Medicaid application. An attorney should also be consulted prior to transferring assets or taking title to property.
As the saying goes, “you don’t know what you don’t know.”
It is important that you see an attorney quickly if you believe that an improper decision has been made about a Medicaid Application. Time is limited, and professional representation which targets breaches of law and regulations is essential. Shanahan & Voigt has the experience and knowledge to represent your interests and have your voice heard.
The attorneys at Shanahan & Voigt, LLC are experienced in advising on all aspects of the Medicaid process.