Medicaid Applicant Cannot Challenge Decision on First Application During Hearing on Second Application

An Ohio appeals court rules that a Medicaid applicant whose second application for Medicaid was approved cannot make the benefits retroactive to the first application. The applicant did not properly appeal the first application, so the decision is final and binding. Estate of Hunter v. Ohio Department of Job and Family Services (Ohio Ct. App. 8thDist., No. 105851, May 17, 2018).

Oscar Hunter entered a nursing home and applied for Medicaid. When the state denied the application, the nursing home filed a request for a hearing. The state denied the request because the nursing home did not have authority to act on behalf of Mr. Hunter. The nursing home secured the permission to act on behalf of Mr. Hunter and filed another Medicaid application on his behalf, which was approved.

Mr. Hunter sought a hearing on whether the second application should have been made effective from the date of the first application. The state denied the hearing, and Mr. Hunter appealed to court, arguing that the state didn't properly process the first application. The court denied Mr. Hunter's hearing request, holding that Mr. Hunter could not "bootstrap" challenges to the first application for benefits in an appeal from the separate second application. Mr. Hunter appealed.

The Ohio Court of Appeals, Eighth District, affirms, holding that Mr. Hunter's failure to appeal the denial of the first application means that the decision is final and binding. According to the court, "even if we consider the nursing home’s request for state hearing to be a nullity, [Mr.] Hunter was nonetheless required to adhere to the 90-day time limit for seeking a state hearing." The court rules that Mr. Hunter "is foreclosed from relitigating questions resolved in the [first] denial of benefits in the [second] application for benefits."

For the full text of this decision, go to: https://www.supremecourt.ohio.gov/rod/docs/pdf/8/2018/2018-Ohio-1969.pdf

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