In order to initiate the Medicaid application, documents are submitted in the county where the recipient resides or if he is in a nursing home, the county where the nursing home is located. Though not an exhaustive list, the following documents are representative of what is required:
Social Security Card
Driver’s License/ State ID
Proof of age
Proof of residence
Costs of housing
Proof of Citizenship (unless receiving SSI or Medicaid)
Proof of income
Supplemental Medical Insurance Card
Proof of Assets/Resources
Trust Agreements, if any
Income Tax Returns
After reviewing the information, the Medicaid agency will advise either the applicant or the person authorized to represent the applicant, that the application is approved, denied, or if more information is requested.
If an application is denied the applicant may request a State hearing. He may also request a county conference in an attempt to resolve the issues at the county level: if resolved, the State hearing request may be dismissed.
It is crucial that the appeal periods for an initial application or a re-application be followed. A person appealing a decision has an opportunity to request and review the agency’s file, obtain a copy of the appeal summary which states the factual and legal basis for the agency’s action, and have subpoenas issued for witnesses.
Hearings are guided by the rules of civil evidence but are not bound by those rules and all relevant evidence may be considered.
Although the State hearing is recorded it does not become part of the official record. Therefore, submission of evidence in document form is essential.
The record consists of the decision and documents submitted. The hearing may be conducted by telephone, in-person, or video conferencing. The agency and the applicant may call witnesses and cross-examine the other side’s witnesses.
The State hearing office shall issue a decision within 70 days from the hearing date. The decision shall be based on State law, State agency regulations, and local agency policies where county options are authorized by State law.
If a decision at the state hearing level is unfavorable, the applicant may proceed to an Administrative appeal. The appeal is decided by a hearing officer who was not involved in the State hearing decision being contested. There are no witnesses, no hearing and no oral argument.
If the applicant receives an unfavorable decision on his administrative appeal, he may file an action for judicial review in the common pleas court located in the applicant’s county of residence.