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Medicaid-ineligible spouse must be included to determine income limit for Medicare Savings Programs.

Pursuant to its policy manual, the Division of Family and Children Services determined the income limit for Q-track Medicaid programs according to the federal poverty level for an individual where the applicant had a Medicaid-ineligible spouse.  This policy contradicted the plain language of the Medicaid Act, which required that eligibility be determined based on “the […]

Medicaid-ineligible spouse must be included to determine income limit for Medicare Savings Programs. Read More

Allegations not included in Statement of Matters Asserted cannot serve as a basis for sanction.

The Georgia Board of Nursing was authorized to impose a sanction against a licensee due to her violation of a consent order wherein she agreed to abstain from alcohol and controlled substances, attend aftercare treatment, and ensure that the Board received quarterly aftercare reports.  However, the Board could not base its proposed sanction on allegations

Allegations not included in Statement of Matters Asserted cannot serve as a basis for sanction. Read More

Resource level required for spouse to live in community must be determined using reasonable method.

A nursing home resident and his spouse, who resided in the community, were denied Nursing Home Medicaid because their combined resources exceeded program limits.  Federal law allowed for redetermination of the resource limit where it was necessary to allow the community spouse to generate sufficient income.  However, federal authority only instructed the state to use

Resource level required for spouse to live in community must be determined using reasonable method. Read More

Agency’s adverse action letter failed to comport with standards of due process.

The Department of Community Health’s letter denying the Petitioner’s request for an increase in occupational therapy was “so lacking in grammar and syntax that it [was] largely incomprehensible,” and thus denied the Petitioner the adequate notice required under Georgia law and the principles of due process.

Agency’s adverse action letter failed to comport with standards of due process. Read More

TANF applicant entitled to conciliation following first material violation.

A TANF applicant’s failure to attend a meeting due to her mistake in recording the date and time of the appointment constituted a material violation of program rules. However, as the applicant’s failure to keep the appointment was the first material violation she had committed, the Division of Family and Children Services erred in closing

TANF applicant entitled to conciliation following first material violation. Read More

Acceptance of partial payment insufficient to show alteration of Admission Agreement.

The fact that the owner of a personal care home accepted partial payments from a resident did not alter the terms of the Admission Agreement where the resident assured the owner he would make up for the difference in payment at a later date.  Therefore, the facility was not required to provide the resident with

Acceptance of partial payment insufficient to show alteration of Admission Agreement. Read More

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