After J.C. was admitted to a nursing facility, her son, S.C., submitted an application to the Camden County Board of Social Services for Medicaid benefits on her behalf. The county welfare board notified J.C. that she was eligible for long-term care benefits but her transfer of assets for less than full market value during the look-back period subjected her to a transfer penalty. Subsequent notices further advised J.C. of her right to request a waiver of the penalty for undue hardship, or to request a fair hearing within 20 days of notice.

Several months later, the nursing home where J.C. resided, via Future Care Consultants, requested a fair hearing of the agency’s decision but it did so before being designated as J.C.’s personal representative. Later, Division of Medical Assistance and Health Services (DMAHS), the state Medicaid agency, requested a completed Authorized Representative Form designating Future Care Consultants as J.C.’s personal representative. Future Care failed to send the Authorized Representative Form for another three months, by which time DMAHS closed the case.

Schutjer Bogar LLC, attorneys for Future Care Consultants, then filed an appeal and requested a Fair Hearing. However, the Medicaid  agency denied the request for a Fair Hearing as being untimely.

The nursing home appealed the agency’s decision denying the request for a fair hearing. On appeal, counsel argued that Future Care’s request was perfected as soon as practicable due to S.C.’s lack of cooperation. The appeal’s court rejected J.C.’s argument and affirmed the county board’s decision. The court noted that the county board provided Future Care with nearly four months to perfect its appeal, and repeatedly advised that the case would be closed without all necessary documentation. As a result, the appeals court ruled as follows:

[W]e cannot find the agency decision to deem Future Care’s request for a fair hearing as out of time to be arbitrary, capricious or unreasonable. … [A]n appeal will not lie from an agency’s failure to respond to requests for action filed grossly beyond the time allotted by regulation.

The case is annexed here – J.C. v. Division of Medical Assistance and Health Services

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