New Jersey Medicaid Appeals Lawyer

II. Medicaid Appeals

Medicaid Eligibility Determinations

After an application is submitted, the local Medicaid agency will eventually make an eligibility determination, and the application either will be approved or denied. If an application is denied, the applicant has a right to appeal and request a fair hearing. Denials are often made in error and an appeal is necessary to correct the error.

All Medicaid programs are required to issue the applicant a written denial explaining the basis for the determination and procedures to appeal. Failure of the denial notice to explain the denial or give adequate instructions to the beneficiary on how to appeal can void the denial of services. In New Jersey, the applicant must appeal the denial in writing within 20 days of the receipt of the denial notice. Failure to file a timely appeal may result in the denial being affirmed. If the applicant appeals the denial on a timely basis, the State must grant the applicant an administrative hearing, called a Fair Hearing. At the Fair Hearing, a hearing officer must provide a plenary review of the evidence, and an adjudication of all issues on appeal.

Medicaid Appeal Hearings

Medicaid Fair Hearings are very informal. Although traditional court rules of procedure and evidence are followed, the hearing officer will frequently allow both sides latitude to enter all relevant evidence into the record. The ruling of the hearing officer is limited to whether or not Medicaid complied with federal and state rules and regulations in denying eligibility.

The appeal process does not end with the ruling of the hearing officer. The Medicaid Director must approve or reject the hearing officer's ruling before it becomes official. If the initial denial of benefits is upheld by the Medicaid Director, the only recourse for a Medicaid applicant is to appeal to a court of law. In New Jersey, the appeal is to the Appellate Division of the Superior Court of New Jersey.

Medicaid Appeals Assistance

Attorneys at the Law Office of Donald D. Vanarelli handle all levels of appeal to assist clients who have been denied Medicaid or other public benefits. Our work includes both Fair Hearings at the administrative level, and more formal proceedings in state or federal court. While most cases are settled without court intervention, we have the experience to take cases to the highest levels of review if necessary.

Medicaid Applications and Medicaid Appeals Attorney

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II. Medicaid Appeals

Medicaid Eligibility Determinations

Medicaid Appeal Hearings

Medicaid Appeals Assistance

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