Cowart Dizzia LLP Continues Winning Streak on Behalf of New York Medicaid Applicants

In the wake of the pandemic’s initial rise,  the New York State Department of Health (DOH) issued guidance to alleviate the considerably burdensome application process for the nursing home applicant population to permit attestations in lieu of corroborating documentation to determine an applicant’s eligibility for long-term care benefits.(1) As of April 2020, the Directive provided that but for immigration/identity status, self-attestation for all eligibility criteria must be allowed from the applicant and the information may be verbalized to the Agency. The attestation rules also include attesting to any transfer of assets during the 5-year look-back period.   Despite these rules, certain agencies have failed to apply the pandemic application guidelines evenly to the most vulnerable applicants. 

Since Spring of 2021, Cowart Dizzia LLP has intervened in applicant denials through its long-term care clients to ensure that the pandemic application rules have been consistently and properly applied to applicants that were institutionalized at the height of Covid-19.  To date, CDLLP has prevailed on behalf of skilled nursing facilities and their residents in four Fair Hearing Decisions reversing improper denials and requiring the application of the pandemic directives. IN all four matters, CDLLP successfully argues that the Agency acted outside its discretion in failing to provide an opportunity for an applicant to attest to verification information and to recognize good cause for these applicants’ inability to complete an application due to delays associated with the Covid-19 pandemic. 

The reversal of these and a growing number of denials will mean the award of critical benefits to  those most severely impacted by the pandemic and for whom access to healthcare is essential.  

For more information on these decisions or to discuss a related matter please contact gdizzia@cowartdizzia.com.

1 See General Information System (GIS) message dated April 2, 2020 (GIS 20 MA/04)