Designated Representative Form Does Not Give Nursing Home Authority to File Medicaid Appeal on Resident’s Behalf

An Ohio appeals court rules that a nursing home that was acting as a Medicaid applicant's authorized representative did not have authority to seek an undue hardship exemption on the applicant’s s behalf because the authorized representative form did not include the authority to represent the applicant at a hearing. Peck v. Ohio Dept. of Job and Family Services (Ohio Ct. App., 11thDist., No. 2018-G-0152, June 18, 2018).

Evelyn Peck's son was her agent under a power of attorney and he applied for Medicaid benefits on her behalf. The state imposed a penalty period because Ms. Peck's son had made transfers to himself. Ms. Peck's son executed a form authorizing the nursing home to act as Ms. Peck's designated representative. The form empowered the facility to receive information on Ms. Peck's behalf and to provide verification about her case. The nursing home later submitted a request for an undue hardship exemption on Ms. Peck's behalf.

The state denied the undue hardship exemption, finding that the nursing home lacked standing to file an appeal because the form did not authorize the nursing home to file an application or represent Ms. Peck at a hearing. The trial court agreed, and Ms. Peck appealed.

The Ohio Court of Appeals, Eleventh District, affirms, holding that the nursing home was not authorized to file an appeal on Ms. Peck's behalf. According to the court, "nothing in the Authorized Representative Designation Form could reasonably be construed as authorizing [the nursing home] to prosecute an appeal on [Ms.] Peck’s behalf or even to seek the undue hardship exemption."

For the full text of this decision, go to: https://www.supremecourt.ohio.gov/rod/docs/pdf/11/2018/2018-Ohio-2353.pdf

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