If you have applied for the Maryland Medical Assistance Program (Medicaid) and received either: i) Notice of Denial for Medicaid Eligibility; ii) Notice of Denial for Medicaid Waiver Services; iii) Notice of Reduction of Medicaid Waiver Services; or Notice of Termination of Medicaid Waiver Services, the following will provide you with the basics regarding your appeal rights:
1. You have the right to an appeal (called a “Medicaid Fair Hearing”).
2. Important Appeal Deadlines:
3. If you fail to submit a timely Request for a Hearing, the decision regarding your Medicaid eligibility or Waiver Services will be final.
4. You have the right to request that your hearing be held in the county you reside. The request must be made in the initial Request for Hearing, otherwise the hearing will be held at the Office of Administrative Hearings (OAH) in Baltimore County.
5. Preparing for the Hearing can be overwhelming. Your preparation will most likely include:
a. Obtaining and reviewing the Department of Mental Health & Hygiene (DHMH’s) documents / evidence and witness list;
b. Compiling your witness list (including treating doctors & nurses), interviewing your witnesses and ensuring their appearance at the hearing;
c. Issuing Subpoenas to Adverse Witnesses;
d. Preparing a Pre-Hearing Legal Memorandum;
e. Preparing Direct-Examination Questions;
f. Preparing for Cross-Examination Questions; and
g. Attending a Prehearing Conference and /or Settlement Negotiations.
6. The hearing process can be complicated. It is likely the following will occur during your hearing:
a. Opening & Closing Statements;
b. Direct & Cross Examination of witnesses;
c. Qualification of Expert Witnesses;
d. Direct & Cross Examination of Expert Witnesses (i.e. treating doctors, nurses);
c. Legal Arguments related to the Medicaid statute and case law; and
d. Burdon of Proof, Evidentiary Rules, and Moving Party Issues.
7. The Maryland Medical Assistance Program (Medicaid) is full of complexities, making it tough to navigate for individuals who are not represented by legal counsel. Unfortunately, this results in many individuals with disabilities (both, children and adults) being denied medically necessary health care services, despite being entitled to them.
We, at Starkey Law, LLC, are here to help and offer legal services involving not only Medicaid Fair Hearings, but application for any of the various Medicaid programs and plans, for example:
a. Early and Periodic Screening, Diagnosis, and Treatment provisions (check-ups, speech therapy, medical equipment for children);
b. Managed Care Plans (MCOs);
c. Behavioral & Mental Health Services;
d. Rare and Expensive Case Management Program (REM); and
e. Waiver Programs.
8. Starkey Law, LLC,can also provide guidance on the many qualifications and provisions of the Medicaid Act and can assist you in accessing and managing your Medicaid eligibility.