Appealing the Denial of a Medicaid Application or a Reduction of Medicaid Benefits in New Jersey
Written by Fredrick P. Niemann, Esq. of Hanlon Niemann & Wright, A New Jersey Appeal of Medicaid Denial Attorney
Have You Been Denied Approval for NJ Medicaid?
If So, You Have a Right to a Fair Hearing Appeal
The filing and processing of a Medicaid application is frustrating. After assembling five (5) years worth of financial information and doing everything reasonably requested by the State to achieve eligibility, many applicants and/or their representatives are frustrated by the continual delays and/or demands for additional information. Often the applicant or their representative is unable to reach the case worker assigned to the application in order to obtain a status update or obtain assistance when questions pertaining to the application come up. If this is your experience, you are not alone.
The blame does not always lie with the employees of the County Board of Social Services, rather the blame belongs primarily with a system which is designed to frustrate, delay and then deny applications for New Jersey Medicaid. New Jersey has made a calculated gamble that if they make the application process hard enough people will either walk away or delay their compliance, thus saving the State the funds necessary to provide long term care for its elderly residents. However, you have rights! This is why I wrote this site to give you the information necessary to appeal a wrongful denial of Medicaid eligibility or a reduction in your existing Medicaid benefits. In cases where the state proposes to terminate, reduce or suspend assistance, notice must be given to the Medicaid beneficiary/Applicant detailing the reasons for the proposed action at least 10 days before the action is to be taken. The notice must also advise the person of his or her right to request a fair hearing appeal. If you appeal the state’s decision in a timely manner the Medicaid assistance must be continued until a decision is rendered. The New Jersey Office of Administrative Law has a website that describes the fair hearing process and procedures.
When you’re done, if you need more information or feel a meeting with me is necessary to protect your loved one’s interest, don’t hesitate to contact me at our toll free number (888) 800-7442 or you can email me at firstname.lastname@example.org . You will be glad you did.
Medicaid Applications in New Jersey Are Time Consuming, Complex and Often Result in a Wrongful Denial
HOW DO YOU APPEAL A DENIAL OF MEDICAID ELIGIBILITY IN NEW JERSEY?
If the County Board of Social Services fails or refuses to approve your application within the required 30/45 review period, you are entitled to file an appeal. Further, if your application is denied for any reason whatsoever or the manner in which the application is being processed is unlawful, you have the right to file an appeal. This appeal is called a Fair Hearing Appeal. Fair Hearing Appeals in NJ have to be filed within twenty (20) days of a denial or other official action taken by the County Board of Social Services.
A Fair Hearing Appeal is taken against the County Board of Social Services of the County where you filed the application. It is a proceeding against the county which affords you an opportunity to present your case before a New Jersey Administrative Law Judge. An Administrative Law Judge (ALJ) is a quasi judicial official who is an attorney by education and training and who has achieved the status of Administrative Law Judge by appointment from the Governor. An Administrative Law Judge hears the evidence and makes a decision on the merits of your appeal. Like any quasi-judicial proceeding the burden of proof is upon you to prove your case. This means that you must produce direct evidence by testimony, documents and information which is relevant to the reasons why the appeal was taken. The case is heard by a single judge. There is no jury or other courtroom accessories. The appeal setting consists of the Judge, representatives of the county and you, each producing evidence to create a record which is maintained in audio form. After the hearing the ALJ will issue a decision which is a recommendation to the Director of Medicaid. The Director can accept the ALJ’s decision, reject the ALJ’s decision, or fail to comment on the ALJ’s decision, in which case the ALJ’s decision becomes the final Agency decision.
To be successful you must be prepared. Generally, Fair Hearing appeals should be undertaken with the assistance of legal counsel who is experienced in courtroom cases and litigation otherwise you may fail to produce the necessary witnesses, comply with required procedural rules and/or assemble the necessary evidence to win.
If you have questions concerning your rights to file a Fair Hearing Appeal in New Jersey or want a legal opinion on the likelihood of your success if you are contemplating an appeal, contact Fredrick P. Niemann, Esq., an experienced New Jersey Fair Hearing Appeal of Medicaid Denial Attorney at 3499 Route 9 North, Suite 1-F, Freehold, New Jersey 07728, or email him at email@example.com; you can call him toll free at (855) 376-5291.
What Is the Legal Effect of an Administrative Law Decision on your New Jersey Medicaid Application When You File an Appeal?
As I indicated earlier on this page, an Administrative Law Judge is able to reverse a denial of eligibility by the County Board of Social Services and/or other adverse decisions made by the County. Unfortunately this does not necessarily end the matter. By law, the Director of New Jersey Medicaid has forty five (45) days to either uphold, modify or reverse the decision of the Administrative Law Judge. This means that while you may win before the Administrative Law Judge, the Director of New Jersey Medicaid has the authority to reverse the decision in full or in part. If this happens you still have rights. You have the right to appeal the Director’s decision to the Appellate Division of the New Jersey Superior Court. This appeal is a matter of right and is decided by a three (3) Judge panel at the State Capitol in Trenton, New Jersey. The Appellate Division will review the evidence, testimony and documents submitted before the Administrative Law Judge and will evaluate whether the Director’s decision is lawful or a violation of Federal Medicaid Law.
Often times, an appeal to the Appellate Division is necessary in order to reverse an incorrect and/or arbitrary decision by the Director. And, unlike an Administrative Law Hearing, the Director of New Jersey Medicaid cannot override a decision by the New Jersey Superior Court or a U.S. Federal Judge.
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Let an experienced Medicaid Appeal attorney at Hanlon Niemann & Wright work for you today.
If you would like to discuss your experiences with NJ Medicaid in a confidential manner with a caring and experienced NJ Medicaid appeals attorney, contact Fredrick P. Niemann, Esq.
Toll-Free at (855) 376-5291
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Watch Fredrick P. Niemann, Esq. of Hanlon Niemann & Wright explain the ins and outs of Medicaid Eligibility in this interesting and informative video.
Thank you for sending me the correspondence from Medicaid. Both my sister and I are so relieved that my dad has Medicaid and that my mom will continue to receive his social security. It is a load off our minds.
I want to convey my sincere thanks to Diane, Fred and all in your office who were so kind and supportive while we went through this process. Poor Valerie had to console me at times when I would come in so upset and watch me cry. She was so kind to me, but Diane most of all. She gave me such good advice and were so kind and caring. You may tell Fred that his office is wonderful. His staff truly cares as he does. This whole situation was so daunting but you guided me so well during the process. I have sang Diane’s praises as well as Fred’s. I have shared your office number and Fred’s name with others and recommend your office highly.
From the bottom of my heart, thank you..
I hired Fred Niemann and his staff to obtain Medicaid approval for my dad, John Melella. His office was just awesome. They were efficient, friendly and responsive to our matter. My questions were promptly and thoroughly answered. I was very satisfied with their services and the level of professionalism they demonstrated
My wife and I wanted to express our gratitude for the guidance and patience from you and your staff along this journey. Life is strange at times and the things that bring us together can be just as strange, if not more.
I not only got to put a few bucks in the bank, but got to reconnect with my cousin Sarah, which was a great surprise for me. That alone was worth the journey for me. Getting to know her and the family has been really nice.
I know it was a long day for all of us in mediation, but I really am blessed to have gotten to know you and talk with you. I admire your skills, work ethic and attitude regarding time and Patience. When the opposing attorney was running her big mouth and doing her thing, you never lost your composure, nor your position. I’m hoping it’s one of the nuggets I’m able to take and implement in my personal/professional life.
The short version of this story is that you have a lot to offer people, you’re a true, trusted advisor. Your words and actions seem to align with your values, which is like common sense, very hard to come by now a days. Your staff does a great job as well. Please let them know that as often as you can.
I am a NJ attorney with 40+ years of experience in the practice of law. Medicaid applications are not my area of expertise. I consulted with three law firms who specialize in this area of law. Thankfully, I chose Hanlon Niemann & Wright. The firm is professional, knowledgeable, efficient and responsive. My sister received notice of enrollment into the Medicaid program within 40 days after the law firm filed the application. Lorraine Banach, my legal assistant contact at the firm, was excellent. I will recommend Hanlon Niemann & Wright to all my family, friends and clients who are in need of legal services concerning Medicaid law.
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