No Second Bite for State in Medicaid Appeals

By Doug Chalgian on February 20, 2022

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In a published opinion, the Michigan Court of Appeals clarifies that State agencies who lose Medicaid cases at the administrative level have to live with the results.  Although the case arises out of a dispute involving services provided by the Community Mental Health Department, the legal foundation for the Court’s opinion would seem to apply across the board, including Medicaid appeals involving long term care eligibility and services disputes that come through the Michigan Department of Health and Human Services.

The COA says that although a Medicaid beneficiary who appeals a negative action has the right to both a hearing in front of an administrative law judge and, if that does not go their way, an appeal from the ALJ decision to Circuit Court; the State agency has no right to appeal an ALJ decision to Circuit Court in a Medicaid case.

To read Wiesner v Washtenaw Community CMH, click on the name. 

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mm By: Doug Chalgian
Doug Chalgian

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