After L.K.’s representative filed for Medicaid benefits, Medicaid sent a checklist of documents to be provided within thirty days, including American Funds account statements. Five months later, Medicaid sent a second letter, again seeking the same documents, again within thirty days. After that deadline passed, L.K’s representative sent some of the account statements and advised Medicaid that the remaining documents were forthcoming. Medicaid granted a third extension for an additional 10 days to provide the required documentation. The documents were not supplied by that newest deadline, and on September 19, Medicaid denied the application for failure to provide financial verifications. The day after that denial, L.K.’s representative sent the remaining account statements.
The Administrative Law Judge (ALJ) affirmed the Medicaid denial for failure to provide the necessary verifications, noting that there was no evidence to demonstrate that exceptional circumstances existed that would warrant additional time to provide the documents. The Medicaid Director then adopted the ALJ decision.
On appeal, the appeals court affirmed the denial of Medicaid benefits. The court agreed that an applicant cannot “shift the burden to obtain the requested verifications to establish eligibility to [Medicaid].” The appeals court also rejected L.K.’s claim that the ALJ should have considered the evidence she submitted the day after her application was denied, finding that that information was “irrelevant” to the appeal.
A copy of the L.K. v. Division of Medical Assistance and Health Services case can be found here – L.K. v. Division of Medical Assistance and Health Services
For additional information concerning Medicaid applications and appeals, visit:
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