Medicaid: The Limit is Still the Limit

The Limit is the Limit, Part 2. Petitioner entered the nursing home on April 17, 2007 and applied for Medicaid on February 22, 2008. Petitioner sough retroactive coverage for November 2007 through January 2008. Unfortunately, Petition was over resourced. After designating stock as a burial resource, she still had $5,569.73 on November 1st, $4,077.13 on December 1st, $2,262.17 on January 1st, $3,707.84 on February 1st, and $5,169.38 on March 1st. Petitioner did provide verification that her checking account balance was below $2,000 on April 1st. Petitioner requested IME coverage for the non-covered months, but DFCS denied that request because IME coverage is not available for months when no vendor payment is made. Citing Hospital Authority of Gwinnett County v. State Health Agency, 211 Ga. App. 407, 408 (1993); Kelly v. Lloyd’s of London, 255 Ga. 219, 293 (1985); Reheis v. L.E.A.F., Inc, 216 Ga. App. 699, 702 (1995); Georgia Real Estate Commission v. Peavy, 229 Ga. App. 201, 203 (1997) and Commissioner of Insurance v. Stryker, 218 Ga. App 716, 718 (1995), the ALJ deferred to the agency’s interpretation of its IME policy and affirmed denial of coverage. Note: This case was decided prior to Weldon v. Medows (Fulton Superior Court Docket No. 08-CV-154469 (April 30, 2009) and presumably would have a different outcome today.

OSAH-Paulding-Langston-10-2008.pdf (October 27, 2008).