The fair hearing or the appeal from agency review must give the applicant a de novo hearing if requested. 42 C.F.R. § 431.232(c). A de novo hearing means it starts over from the beginning. 42 C.F.R. § 431.201. The hearing includes consideration of the following: 1. Any agency action, including the following: a. Denial or […]
As a general rule, discovery is not permitted in any proceeding before an ALJ, except to the extent specifically authorized by law. Ga. R. & Regs. § 616-1-2-.38. In Bd. of Dental Examiners v. Daniels, 137 Ga. App. 706 (1976). Appellant/defendant contends that the Civil Practice Act is not applicable to proceedings under the Georgia […]
Form All requests made to the Administrative Law Judge shall be made by motion. Unless made during the hearing, motions shall be in writing, shall state specifically the grounds therefor, and shall describe the action or order sought. A copy of all written motions shall be served in accordance with Rule 11. Ga. R. & […]
Form; timing A Motion for Summary Determination may be filed no later than thirty days prior to the date a case is set for hearing. The motion may be based on supporting affidavits or other probative evidence, for summary determination in its favor on any of the issues being adjudicated on the basis that there […]
An ALJ may order a prehearing conference to simplify the issues being presented. Conferences may be held in person or by telephone. Ga. R. & Regs. § 616-1-2-.14 is analogous to O.C.G.A. § 9-11-16(a) because it allows ALJs to clear up evidentiary and procedural matters before the hearing. Specifically, Rule 14 provides: (1) Conferences. The […]
Minimum Federal Requirements for Medicaid Fair Hearings Each State must give Medicaid applicants the right to a fair hearing when applications are denied, improperly approved, or simply not acted in a timely manner. 42 U.S.C. § 1396a(a)(3); 42 C.F.R. §§ 431.200-431.250; 42 C.F.R. § part 438. The State’s hearing system must provide for a hearing […]
All applications for ABD Medicaid require that the applicant’s basic eligibility be verified. See ABD Manual Section 2201-4. Applications for long-term care Medicaid also require verification of income and resources, but caseworkers are instructed to “For ABD Medicaid verification requirements, see the sections pertaining to the specific COA and the Income and Resource Chapters.” ABD […]
If benefits are being terminated or reduced, the applicant/recipient may request that benefits continue while the appeal is pending. A request for continuation of benefits must be made within ten days following issuance of the notice. See 42 C.F.R. § 431.231(c)(2). Allowance should be made in the event the Applicant’s reports late receipt of notification […]
Right to a Hearing The right to a hearing is a property right and belongs to the applicant. See Bd. of Regents v. Roth, 408 U.S. 564 (1972) (“Property interests, of course, are not created by the Constitution. Rather, they are created and their dimensions are defined by existing rules or understandings that stem from […]
Theoretically, Medicaid should be simple. It’s anything but simple. Also, theoretically, the Medicaid program should be administered in the best interests of Medicaid recipients. 42 C.F.R. § 435.902. Anyone who has worked on more than a few Medicaid applications knows otherwise. Still that’s what federal law requires. 42 U.S.C. § 1396a(a)(19) must “provide that State […]
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