Medicaid: Hire a Lawyer

Hire a Lawyer. An unrepresented nursing home resident applied for Medicaid on December 21, 2007. A 981 was issued after an intake interview on December 27, 2007. However, the 981 erroneously omitted a request for documentation regarding retirement income and social security benefits. The caseworker realized her error on  February 5, 2008 (3 days after expiration of the standard of promptness) and requested the documents. They were provided the next day and it was shown that the resident’s income exceeded the income cap, requiring a qualified income trust. A QIT was established and funded in February. The case was approved for February ongoing, but denied for prior dates. On appeal, the decision was affirmed. You cannot back-date a QIT. Although the caseworker was required to tell the applicant of the need for the QIT within the standard of promptness, the information was communicated in February and the QIT was established in February. Since compliance with the SOP would have the same result, denial of eligibility for December and January was affirmed. This decision cited Doe v. Chiles, 136 F.3d 709, 718 (1998) for the proposition that the SOP carries the force of legal authority and compliance with the standard of promptness is mandatory rather than precatory.

OSAH-Elbert-Miller-6-2008.pdf January 17, 2008).