H.B. 229

I recently received this review of HB 229 from Pat Nobbie from the DD Council. If you have been denied Medicaid and have appealed the case, or know some who has, this bill could help streamline the process.

IF YOU are a Medicaid recipient who has experienced unnecessary delays in a request for a Fair Hearing, OR if you have had a decision in your favor overturned by the Department of Community Health, please write a one page description of your experience and send it to: pnobbie@dhr.state.ga.us.  Please include contact information including a phone number and e-mail address.  Please indicate if you would be willing to speak in support of this legislation when it comes before the committee.  Put “Medicaid appeals” in the message line.  Thanks

H.B. 229:  Increase Efficiency & Preserve Due Process

in Medicaid Appeals Hearings

HB 229 Corrects 2 problems in the Medicaid Appeals Process

Problem 1:  Currently, if an individual is denied Medicaid for any reason – eligibility, frequency, duration or intensity of services, they can appeal that decision to the Department of Community Health and request a Fair Hearing.  DCH must submit the request for a hearing to the Office of State Administrative Hearings (“OSAH”), BUT THERE IS NO REQUIRED TIME FRAME in state law within which the transmittal of the request must occur.  It has been the experience of many families that DCH sits on the requests for a Fair Hearing unnecessarily, leaving Medicaid recipients in limbo.

Federal Medicaid Act requires that if a Medicaid recipient appeals a denial of services and requests a Fair Hearing, the decision on that appeal must be made within 90 days from the date the request for a hearing was submitted.

When DCH sits on those requests for a fair hearing, it cuts into the 90 day time frame the Office of State Administrative Hearings has to render a decision.

Solution:  HB 229 requires DCH to transmit a request for a Fair Hearing to OSAH within 15 days of receiving it, giving the Administrative Law Judges 75 days to hear the case and render a decision.

Problem 2:  After OSAH hears a case and renders a decision, DCH can appeal the decision to itself. Under current Georgia law, DCH can “affirm, modify or reverse” the judge’s decision.  This creates three issues: 1) it is a waste of time as it adds at a minimum an additional 60 days to the appeal process; 2) it undermines the integrity of an appeal process that is supposed to be impartial and fair; 3) it is a waste of resources to have a full-blown hearing only to have the department change the decision as they see fit.  In most of the administrative proceedings before OSAH other than Medicaid appeals (i.e. child support, special education, administrative license suspension, DNR appeals), the judge’s decision is final.  If either party wishes to challenge the result, they may appeal the OSAH decision to Superior Court. 

Solution:  HB 229 removes DCH’s ability to overturn an administrative law judge’s decision.  If either party doesn’t like the Hearing Officer’s decision, they may appeal to Superior Court.  An Impartial Judge’s decision is respected and stands as the Final Administrative Decision.

HB 229 provides an administrative appeal process that is fair and efficient, and protects the integrity and impartiality of the appeal proceedings before the Office of State Administrative Hearings.