Fair Hearing Resources

New York State Permaently Enjoined from Dismissing Medicaid Related Fair Hearing Without Sending Post-Default Inquiry Letter

08 Apr, 2017

On March 29, 2017, Judge Joseph F. Bianco permanently enjoined the New York State Department of Health (DOH) and New York State Office of Temporary and Disability Assistance (OTDA) "from dismissing administrative appeals of defaulting Medicaid appellants who are not given at least ten (10) days to respond to a written notice from defendants inquiring as to whether they would like their hearings rescheduled." Fishman v Daines, 09-CV-5248, Memorandum and Order, at p. 11 (E.D.N.Y. March 29, 2017).

DOH and OTDA were already under a preliminary injunction since April 11, 2016 from dismissing administrative appeals of defaulting Medicaid appellants who are not given at least 10 days to respond to a written notice from defendants inquiring whether they would like their hearings rescheduled. See OAH Procedures Transmittal 16-02.

The Court has not yet issued a Judgement in this statewide class action, which was certified on March 10, 2014 and was defined as

"All past, present and future applicants and recipients of Medical Assistance ('Medicaid appellants') in New York State who:

     "(a) requested or will request an administrative fair hearing from defendants to contest the adequacy, denial, reduction, restriction or termination of Medicaid benefits, and

     "(b) failed or will fail to appear in-person or by representative at any fair hearing scheduled on or after December 1, 2006 in response to such request, and

     "(c) suffered or will suffer dismissal of their administrative appeal without defendants' prior written inquiry, to ascertain whether the administrative appeal has been abandoned."

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Author: Gene Doyle, LMSW.

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