Nursing Home Resident Without Guardian Still Had to File Appeal of Medicaid Denial Within 90 Days

A Maryland appeals court holds that an incapacitated nursing home resident who did not have a guardian still had to file an appeal of his Medicaid denial within 90 days because the nursing home could have appointed an authorized representative to pursue the appeal. Perry v. Maryland Dept. of Health (Md. Ct. Spec. App., No. 418, March 28, 2022) unreported.

Nursing home resident Scott Perry lacked the capacity to manage his affairs. His wife filed a Medicaid application on his behalf as his authorized representative. Maryland’s Medicaid agency requested additional information, which Ms. Perry failed to provide, so the application was denied in June 2018. A nursing home employee filed a second application for benefits on Mr. Perry’s behalf as his authorized representative. After filing the application, the employee left her job at the nursing home. The Medicaid agency requested additional information, but the nursing home did not provide it, and the application was again denied in July 2018. The nursing home filed for guardianship of Mr. Perry, and the court appointed a guardian in February 2019.

The guardian appointed a new authorized representative who filed an appeal of the denials. The Medicaid agency argued that the appeals were untimely because they were filed after the 90-day appeal deadline. The agency dismissed the appeals, and the trial court affirmed. Mr. Perry appealed, arguing that the denial notices violated due process because Mr. Perry was incompetent and had no guardian.

In an unreported opinion, the Maryland Court of Special Appeals affirms, holding that due process does not require that a guardian be appointed before notice of a Medicaid eligibility denial “can be considered effective and start the clock on the ninety-day appeal period.” According to the court, the nursing home had the ability to appoint a new authorized representative to pursue the appeal, but failed to do so in a timely manner.

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