Print This Article

No Right to Fair Hearing Unless You Complain About Something

In L.U. v. Division of Medical Assistance (N.J. Superior Court Docket A-2937-20, May 23, 2023), the Superior Court affirmed denial of L.U.’s request for a fair hearing. How, you ask? “I thought everyone had a right to a fair hearing!!! Well, apparently not.

L.U. was an unrepresented Medicaid recipient. He appealed from a May 11, 2021 final decision denying his request for a fair hearing. Apparently his complaint centered on alleged improper treatment of his medical condition. But when his case was heard, he acknowledged he had received uninterrupted Medicaid benefits since 1996 and all his benefits were covered by Medicaid. in explaining to the lower court judge why Medicaid denied L.U’s request for a fair hearing, they said that while “an individual was entitled to a fair hearing “to contest an action by Medicaid regarding eligibility or services,” but “there [was] no basis to grant [L.U.] a fair hearing” because L.U. had submitted nothing that was “actionable.” In other words, he failed to claim Medicaid did anything wrong.

Since L.U. failed to identify any challenge to the agency’s action, which he admitted, he was not contesting an agency action and was not entitled to a fair hearing.


Requesting a Medicaid Fair Hearing
42 C.F.R. § 431.220(a)(1)
N.J.A.C. 10:49-10.3(b) (as of this post, N.J. posted a 241 page pdf from the Lexis version of its administrative manual and the relevant section is at page 201)

Start Here

Enter your name and email address to keep up with what’s new at EZ Elder Law!

  • This field is for validation purposes and should be left unchanged.