Big Change to Medicaid

By Fredrick P. Niemann, Esq. of Hanlon Niemann, a Freehold, NJ Medicaid Attorney

The Appellate Division of the Superior Court of New Jersey decided an interesting case. The case, Greta Reuter v. the Burlington County Board of Social Services, addresses the contents of any notice the state must give an applicant who is denied Medicaid benefits.

If your application for Medicaid benefits is denied, the County Board of Social Services must provide you with a notice of the denial. The denial notice must inform you of the right to appeal this denial through a process called a “fair hearing appeal”. An applicant who is denied benefits has twenty days from the date the notice of denial is issued to file for a fair hearing.

Based upon my experience, I can tell you that I often receive a denial notice that is dated many days (if not weeks) before I received it at the office. There are many reasons why these delays occur.

The issue of proof of timely service of a notice of appeal, or in this case an untimely notice of appeal of an adverse Medicaid decision is one that I have often thought about. For one thing, how will the county and/or state prove that I received a denial notice since they do not send the denial notice by certified or registered mail?

The Reuter case answers this question. Essentially, Mrs. Reuter did not file her request for an appeal within the twenty-day time period. The county and state denied her request for an appeal, claiming that her request was untimely. Mrs. Retuer claimed that she never received the denial notice.

In the end, the court agreed with Mrs. Retuer, holding that the county and state could not prove that Mrs. Retuer ever received the denial notice. The outcome of this case was the correct one.

New Jersey court rules provide that proof of service is to be made when I want to prove a party received a notice that I sent, I send the notice by regular and certified mailing or by personal service. I cannot just say, “I sent it”. I have to prove that I sent the notice and the recipient received the notice.

While the County Boards of Social Services probably do not want to spend money on certified mailings, the fact of the matter is, a denial notice implicates important due process rights. A Medicaid applicant who is adversely affected by the decision of the County Board of Social Services must be provided with notice of the denial and his right to appeal the adverse decision.

To discuss your NJ Medicaid matter, please contact Fredrick P. Niemann, Esq. toll-free at (855) 376-5291 or email him at fniemann@hnlawfirm.com/. Please ask us about our video conferencing consultations if you are unable to come to our office.

Posted in Medicaid.