Medicaid eligibility determinations must be based on “ascertainable standards.” See J. Perkins, Issue brief: Appeal Rights and Medicaid Benefits citing Holmes v. New York City Hous. Auth., 398 F.2d 262, 265 (2d Cir. 1968). In Holmes, in the context of housing authority decisions, the Court said “due process requires that selections among applicants be made […]
A record must be kept in all contested cases. 42 C.F.R. § 431.244 provides: (b) The record must consist only of— (1) The transcript or recording of testimony and exhibits, or an official report containing the substance of what happened at the hearing; (2) All papers and requests filed in the proceeding; and (3) The […]
In preparing the original version of these materials several years ago, I spoke with one of the Administrative Law Judges (the Hon. Patrick Woodard) regarding what Judges want advocates to know about hearings. Make copies. Although you may presume your judge knows Medicaid law, don’t presume your judge is a Medicaid expert. Make copies of […]
Same rules as non-jury civil cases The rules of evidence applicable in civil nonjury trials apply in administrative hearings. O.C.G.A. § 24-1-2(d)(4); Ga. R. & Regs. § 616-1-2-.18(1)(a). Irrelevant, immaterial, or unduly repetitious evidence shall be excluded. When necessary to ascertain facts not reasonably susceptible of proof under such rules, evidence not admissible thereunder may […]
The Applicant and DFCS have the right to the following: 1. Bring and/or subpoena witnesses; 2. Establish all pertinent facts and circumstances; 3. Present arguments without undue interference; 4. Question or refute any testimony or evidence, including the opportunity to question and cross-examine adverse witnesses. 42 C.F.R. § 431.242(b) through (e). DFCS has the responsibility […]
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 […]
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