The Appellate Division of the Superior Court of New Jersey recently decided an interesting case. The case, entitled Greta Reuter versus the Burlington County Board of Social Services, involves the notice requirement for a Medicaid denial.
Medicaid is a federal and state health insurance program for needy individuals. In order to qualify for Medicaid benefits, an individual must have a limited amount of assets. Unlike most policies of health insurance, Medicaid will pay for long-term care, such as care in a nursing home.
When an individual applies for Medicaid benefits, he files his application with the county board of social services for the county in which he resides. So, for instance, if Mr. Smith is living in a nursing home in Monmouth County, then Mr. Smith would file an application for Medicaid benefits with the Monmouth County Division of Social Services.
If your application for Medicaid benefits is denied, the county board of social services must provide you with a notice of the denial. The denial notice must inform you of the right to appeal the denial of benefits through a process called a “fair hearing.” An applicant who was denied benefits has twenty days from the date on the denial notice to file for a fair hearing.
I have probably filed over a thousand applications for Medicaid benefits. As one might expect for someone who has filed that many applications, I have received my fair share of denial notices.
Based upon my extensive experience, I can tell you that I often receive a denial notice that is dated many days if not a couple of weeks before I received the notice. County boards have mail rooms and their mailings are often delayed.
While I have never had a situation in which the State/County claimed that I failed to file an appeal of an adverse Medicaid decision in a timely manner, I have often thought about the issue. One thing that often crossed my mind was the question, How would the county and state prove that I received a denial notice since they do not send the denial notice by certified or registered mail?
The Reuter case answers this question. Essentially, Mrs. Reuter did not file her request for an appeal within the twenty-day time period. The county and state denied her request for an appeal, claiming that her request was untimely. Mrs. Reuter claimed that she never received the denial notice.
In the end, the court agreed with Mrs. Reuter, holding that the county and state could not prove that Mrs. Reuter ever received the denial notice. This case makes a great deal of sense.
As a lawyer, when I want to prove a party received a notice that I sent, I send the notice by regular and certified mailings or I have the notice personally delivered by a service processor. I cannot just say, “I sent it.” I have to prove that I sent the notice and the recipient received the notice.
While the county boards of social services probably do not want to spend money on certified mailings, the fact of the matter is, a denial notice implicates important due process rights. A Medicaid applicant who is adversely affected by the decision of the county board of social services must be provided with notice of the denial and his right to appeal the adverse decision.
The Reuter decision is an important reminder that receiving a Medicaid denial is only the beginning of the appeal process. An applicant must receive proper notice of the denial and understand the right to request a fair hearing. When Medicaid is needed to pay for long-term care, that right to appeal can be critically important.