Can an Elder Law Attorney help when Medicaid is Denied or Terminated?

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Medicaid for long term care services is a program that provides benefits to someone with disabilities, or who is legally blind, and those older than age 65. The applicant must meet certain requirements regarding income, resources, and level of care required. The applicant also cannot have given away assets for less than fair market value within the sixty months prior to the application.

When a Medicaid application is made, the office of Aging and Disability Services of the Department of Human Services (the agency that administers Medicaid in Oregon) must provide the applicant a written notice approving or denying eligibility for services. The written notice must cite the rule(s) that led to the agency’s decision and describe the applicant’s hearing rights.

Any denial notice, or notice of termination for someone already qualified for Medicaid, entitles you to a hearing if requested in a timely manner. You must complete a special hearing request form and submit it to the agency within 45 days of the date of the decision notice. When a request for hearing is not filed within the 45 day period, a hearing may still be granted if the delay was beyond your control or for other good reasons. If you are already receiving Medicaid benefits but are determined no longer eligible for those benefits, you may request to continue benefits until the date of the hearing. You must make the request to have benefits continue within 10 days of the date of the decision notice.

Once a hearing request has been filed, a hearing date will be scheduled. You are entitled to have an attorney represent you in this process. Prior to the hearing, there will be a conference with the agency representative to discuss the issues that led to the decision notice and see if the issues can be resolved. If the issues are resolved the hearing is canceled.

If the matter has not been resolved prior to the hearing, an Administrative Law Judge (ALJ) conducts the hearing and usually makes a final determination. The hearings are usually held by telephone and witnesses may testify by telephone. The final order must include a statement of the issues, references to relevant statutes or rules, findings of fact, and conclusions of law.

If you disagree with the final order, you may appeal it to the Oregon Court of Appeals. However, you must file a petition for review within 60 days of the final order.

An experienced Elder Law attorney can help you understand Medicaid benefits, the application process, and your rights if the application is denied. Contact the Elder Law attorneys with the Law Offices of Nay & Friedenberg in Portland, Oregon at (503) 245-0894 to set an appointment.

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