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Court Ruling Speeds Medicaid to Disabled

On February 1, 2006, the Court of Special Appeals issued a favorable reported opinion in the case of Albert S. v. DHMH. (click here to read the court's decision, and click here to read the Daily Record article on the case, quoting PJC attorney Carolyn Johnson).

The case concerned the common practice of Maryland’s Administrative Law Judges, who hear the appeals when the Department of Health & Mental Hygiene denies a person's application for Medical Assistance based on their disability.  Even when the ALJ's received persuasive evidence of disability at the appeal, they frequently remanded the cases back to the agency to reconsider the agency's denial, rather than simply rendering a decision on the merits of the applicant’s eligibility.  This often resulted in the delay or denial of benefits for the person for many months as the case wound its way up and down the appeal process.

The Appellant, Albert S., was represented by the Legal Aid Bureau.  The Public Justice Center submitted an Amici Curiae brief on behalf of the PJC, Health Care for the Homeless, Maryland Disability Law Center, AARP, The Homeless Persons Representation Project, The Civil Advocacy Clinic of the University of Baltimore School of Law, The Health Education Resource Organization, NAMI Maryland, and Medicaid Matters Maryland.  The brief was written by PJC attorneys Carolyn Johnson and Wendy Hess.

The Court found that while the issue was technically moot because Albert S. had eventually received his Medical Assistance it “is worthy of our consideration because of its public importance and because the issue could evade judicial review.”  In explaining the public importance of the issue the Court quotes several arguments presented by Amici.  “Noting the impact of the procedural error upon indigent applicants, the amici emphasize as ‘manifold’ the ‘importance of the fair hearing decision-maker reaching a decision on the merits…”  “Amici assert:
 

This practice of ‘remanding’ causes real harm to indigent individuals with disabilities. While applications are delayed for many months, these vulnerable individuals may have to delay or forego necessary medical care, incur financial debt, and sacrifice other necessities like food and rent to try to pay for medical care.”
 

The Court then reaches the merits of the case and finds that, “it was the ALJ’s obligation to render a decision on the merits of the appellant’s application for Medicaid based on a disability.”

This decision is the result of many years of collaborative efforts by advocates and will have a profound impact on how disputes over Medicaid eligibility are resolved through the fair hearing process.  Individuals disputing the denial of Medicaid benefits will now receive the due process to which they have always been entitled but never afforded.



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