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 […]

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 […]

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 […]

Taking over a case started by someone else is never my preference. It’s far easier to do something correctly the first time. So what do you do when you’re brought in to fix a case. You pray! First, if someone hires you and no decision has been made, review the file. If there is an […]

Both O.C.G.A. § 49-4-153(b)(1) and 42 C.F.R. § 431.244(g) require that all Medicaid agency decisions be accessible to the public, except that 42 CFR § 431.305(b) requires that the following information must be safeguarded: (1) Names and addresses; (2) Medical services provided; (3) Social and economic conditions or circumstances; (4) Agency evaluation of personal information; […]

Right to Hearing, Generally Medicaid applicants and beneficiaries are entitled to adequate notice of state agency actions and a meaningful opportunity for a hearing to review those decisions whenever their claim for benefits is denied or not acted upon with reasonable promptness. Federal law, at 42 U.S.C. § 1396a(3); 42 C.F.R. Part 431, Subpart E, […]

There are times when formal “legal” communication is necessary. This post addresses several instances regarding how that can be done. It is not meant to be all inclusive and, in many cases, specific communication rules apply. Beginning a lawsuit: When you begin a lawsuit, a summons must be served on the Defendant(s). Generally, Rule 4 […]

In a recent case (Dep’t of Tenncare 4/20/2022), Appellant’s application for nursing home Medicaid was denied due to ownership of a life insurance policy with a cash value of $2,184.66. She had been under a limited conservatorship since June 2, 2021. The Medicaid application was filed on July 21, 2021. Neither Appellant nor the limited […]

In Weeks v. DHS, Division of Family and Children Services, Office of State Administrative Hearings, Docket 2117014 (April 28, 2021), Brian Center Health and Rehabilitation – Canton, purportedly filed a direct appeal on behalf of Marilu Weeks after her Medicaid application was denied. Judge Teate, in Docket No. 2115533, directed Brian Center to provide evidence […]

In 1984, the U.S. Supreme Court decided Chevron v. Natural Resources Defense Council, Inc., 467 U.S. 837 (1984). Chevron concerned an EPA environmental regulation. The amended Clean Air Act required these “nonattainment” States to establish a permit program regulating “new or modified major stationary sources” of air pollution. Generally, a permit may not be issued […]

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