Has your loved one been receiving home care services under any of the New Jersey Medicaid Home and Community-based programs such as Global Options? The State’s Comprehensive Medicaid Waiver replaced that program with MLTSS – Medicaid Long Term Services and Supports — and each recipient is assigned to a Managed Care Organization (MCO) which performs a care plan assessment and determines the amount of hours of services to be provided to the Medicaid participant. There is an individual capitation rate assigned for each participant, which is a dollar cost for services. To read the State’s Fact Sheet, published by DMAHS (Division of Medical Assistance and Health Services), look at Consumer_FAQs
Cases are beginning to appear in which the amount of hours is being reduced without there being any actual decrease in the participant’s level of medical need. This raises many legal issues which might even be constitutional in nature, and you should promptly consult with an elder law attorney.
These adverse decisions can be appealed by filing a Request for Hearing before the Office of Administrative Law. The appeal request must be filed promptly — you have just 20 days from the date the Notice is actually served on the participant. The hearing is an administrative trial – records need to be obtained, evidence and legal briefs would be submitted, and the hearing involves presentation of witnesses who testify about the relevant issues. Subpoenas may have to be issued to the State to obtain evidence. If all of the issues aren’t properly presented, there is a risk of waiving your rights without even realizing it.
Call us for representation on Medicaid fair hearing appeals … 732-382-6070