CCSP applicant should not be penalized when agency worker misplaces medical records

Topic: Medicaid Eligibility, Decided by: Judge Schroer 
Docket Number: 0000000 , Decision Date: July 6, 2023 
Attachment: Click here to download the decision. 

The OSAH Judge reversed the Department of Community Health’s denial of a Community Care Services Program (CCSP) application because it was “incomplete.”  The applicant’s daughter had provided a binder of medical records to a review nurse during the application process, but that review nurse left employment before completing her review and without returning the binder.  The Judge identified three errors in the denial.  First, the Department failed to provide assistance to the applicant, as required by federal regulations.  Second, the Department’s initial denial letter did not constitute a request for medical records in “plain language and in a manner that is accessible and timely,” as federal law requires.  Third, the denial was inconsistent with the federal requirement that the Department implement procedures that ensure eligibility is determined in a manner consistent with the best interest of the applicant. 

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