Due process

With the nationwide end of the pandemic-related continuous coverage/maintenance of effort policy that was in effect from March 17, 2020 until Mar 31, 2023, there has been a nationwide spotlight on administrative barriers that result in eligible Medicaid members losing coverage at…

MassHealth has started posting fair hearing decisions on its website. As of February 2024, there are over 2400 decisions from July -Sept 2023 currently posted with a filtering feature by topic. 

Attached are excerpts from the State Auditor's FY 2023 BSI Annual Report in which it explains that CMS prohibits collection of overpayments from beneficiaries (except in limited circumstances) and that pursuant to this directive, the BSI has suspended civil collection of beneficiary overpayments and…

This settlement with the Executive Office of Health and Human Services (EOHHS) arises out of several consolidated cases brought in Suffolk Superior Court. Congratulations to Nicholas Kaltsas of Elder & Disability Law Advocates, John Welch of Life Care Planning Law Group, and John Ford of the…

In this Aug 5, 2021 Appeals Court decision, the Court reversed the Superior Court's summary judgment in favor of EOHHS in a Medicaid estate recovery claim under G.L. c. 118E, Sec. 31 in which the claim consisted entirely of capitated monthly payments to a Senior Care Options (SCO) program.…

This is a declaratory judgment decision in two companion cases filed in Suffolk Superior Court, Maas v. Sudders and Hirvi v. Sudders, by 2 private attornies & members of the MA Chapter of the Natl. Assoc. of Elder Lawyers (NAELA). Each case was filed as an affirmative action seeking to…

This is a redacted Complaint seeking judicial review of the Board of Hearings final action denying the appellant's motion to vacate the dismissal of his appeal. The issue was whether he had good cause for his failure to appear. His counsel, Nancy Lorenz of GBLS, reports that the agency agreed to…

Practice and Procedure at the Division of Medical Assistance Board of Hearings