State Denied Medicaid Applicant's Right to Submit Additional Brief and Evidence on Appeal

A Kentucky appeals court holds that the state improperly denied a Medicaid applicant the right to submit an additional brief and new evidence when appealing an adverse administrative law judge's decision. The applicant was represented by two ElderLawAnswers member attorneys. Marcum v. Cabinet for Health and Family Services (Ky. Ct. App., No. 2015-CA-000047-MR, July 15, 2016).

In 2011 and 2012, nursing home resident Betty Marcum applied for Medicaid benefits, and the state denied her application. Ms. Marcum owed payment to the nursing home in November 2012 and January 2013. Her daughter paid the nursing home and signed a promissory note, stating that Ms. Marcum owed her for the payment. Ms. Marcum reapplied for benefits in January 2013 and requested benefits retroactive to November 2012. The state granted Ms. Marcum benefits going forward, but denied the retroactive benefits because there was no outstanding nursing home bill.

Ms. Marcum appealed the denial of retroactive benefits. When an administrative law judge denied the appeal, Ms. Marcum filed an exception. State law required the state to acknowledge an appeal in writing and offer the opportunity to submit further evidence, but the state entered a final order denying her appeal. On appeal, the trial court determined that Marcum received sufficient due process, and Ms. Marcum appealed.

The Kentucky Court of Appeals reverses and remands the decision because the state did not provide Ms. Marcum with an opportunity to submit a new brief or new evidence. According to the court, while the trial court held that Ms. Marcum "received sufficient due process under the circumstances, for us to affirm ignores clear provisions of the administrative procedure set up for Medicaid appeals."

Representing Ms. Marcum were ElderLawAnswers member attorneys Robert McClelland and Mark Maddox of the Lexington firm of McClelland and Associates, PLLC.

For the full text of this decision, go to: https://162.114.92.72/COA/2015-CA-000047.pdf

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