Late last week, MassHealth implemented significant changes to its regulations on filing and pursuing an appeal for a Medicaid applicant who has passed away. The changes, impacting both providers and applicant’s families, place a number of hurtles in the appeal process and pave the way for MassHealth to dismiss previously proper appeals. The Board of Hearings now requires that it be informed at the time of appeal that the applicant is deceased. The party filing the Fair Hearing Request must also attach their appointment as Personal Representative of the applicant’s estate. Alternately, the party appealing must attach written proof that a petition is pending with the court of proper jurisdiction for their appointment as Personal Representative of the applicant’s estate. In addition, monthly updates on the status of opening the estate must be submitted to the Board of Hearings. Once the appointment is made, the Board of Hearings must be informed of the appointment of the Personal Representative within 10 days. Failure to follow these new rules is grounds for dismissal of the appeal. These changes to the code of regulations can be found at 130 C.M.R. § 610.000. The changes were initially proposed in December 2016. They were implemented as of August 9, 2019.
These rules place a substantial burden on providers and applicant’s families who want to challenge adverse determinations by MassHealth – determinations which can improperly deny the applicant MassHealth benefits. The deadline to appeal a determination by MassHealth, set forth at 130 C.M.R. § 610.015(B), expires 30 days from the date of the determination is received. In order to file an appeal, the applicant’s provider or family will need to act extremely quickly to open an estate to comply with the new regulations. MassHealth’s new rules fail to take into account the applicant’s family’s need to grieve their loss, as well as the practical constraints of filing a probate petition: filing costs, the time it takes for the Court to appoint the Personal Representative, and the potential need for the filing parties to consult with an attorney regarding the petition, the probate process, and the responsibilities of the Personal Representative.
In most of these cases, the deceased applicant is indigent and MassHealth benefits are the only potential source of recovery for the provider. To meet the new deadlines, providers will need to closely monitor accounts for deceased applicants and take prompt action if MassHealth denies benefits or fails to comply with federal and state law in processing the applicant’s MassHealth application. This will be paramount to avoid the dismissal of appeals and loss of MassHealth benefits.
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Please note that this information is for educational purposes only and is not intended as legal advice and does not create an attorney client relationship.