An Ohio appeals court rules that a nursing home acting as a Medicaid recipient’s authorized representative has standing to challenge a benefit denial due to a life insurance policy, and that the Medicaid agency must assist in determining the policy’s availability to the recipient. Tiggs c/o Indianhills Healthcare Group, Inc. v. Ohio Dept. of Job and Family Services (Ohio App., Eighth Dist., No. 106022, Aug. 9, 2018).
Nursing home resident Persey Tiggs’ Medicaid benefits were canceled in September 2015 when the Ohio Department of Job and Family Services determined that a life insurance policy he had acquired made him financially ineligible for benefits. Subsequently, Mr. Tiggs’ guardian executed a document appointing the nursing home as his authorized representative for Medicaid purposes. In that capacity, the nursing home reapplied for Medicaid benefits for Mr. Tiggs but the application was denied due to the life insurance policy.
The nursing home appealed the decision administratively, arguing that the life insurance policy was unavailable to Mr. Tiggs because he was the policy's insured, not its owner, and because the policy’s owner was deceased. Ultimately, the agency found that the policy was available to Mr. Tiggs and upheld the benefits cancellation. The nursing home appealed this decision to a trial court, which ordered the agency to determine if the nursing home or Mr. Tiggs’ guardian could assist him in accessing the life insurance policy and to refer the matter to the agency’s legal counsel for further review if neither could assist.
The agency appealed the trial court’s decision, arguing that the nursing home lacked standing to represent Mr. Tiggs in court regarding the termination of his Medicaid benefits and that the trial court erred in finding that the agency had a duty to assist Mr. Tiggs to determine the availability of the insurance policy.
The Court of Appeals of Ohio, Eighth District, finds that as Mr. Tiggs’ authorized representative, the nursing home has standing to act in all Medicaid matters on his behalf and affirms the trial court’s modified order. The court dismisses the agency’s challenge to the finding that it had a duty to assist Mr. Tiggs in determining the availability of the policy, concluding that because the decision was not based on “the constitutionality, construction or interpretation of a statute or agency rule,” the agency lacked standing to appeal that aspect of the trial court’s decision.
In a separate opinion, one justice dissents from the majority’s conclusion that the agency lacks standing to challenge the finding that it had a duty to assist Mr. Tiggs, concluding that Mr. Tiggs’ arguments required the interpretation of administrative rules and raised questions of law that were appealable by the agency.
For the full text of this decision, click here.
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