In April 2024, a Medicaid application was denied, putting the operator at risk of significant financial loss. The County delayed its response for nine months, ignored repeated follow-ups, and continued to demand documentation for an account that belonged to the applicant’s deceased ex-spouse. Even after the bank confirmed no such account existed, the County failed to correct its request.
Our Advocacy
Our Advocacy FCC’s team represented the operator before the Administrative Law Judge (ALJ). We demonstrated that the application had been handled in good faith, with timely responses to every request, numerous follow-up communications, and even subpoenas issued to the bank to provide independent confirmation.
The Outcome
The Outcome The ALJ overturned the denial, ordering the County to reopen the application, issue a new Request for Information (RFI), provide a reasonable timeframe for response, and make a new determination. This decision reversed the financial impact of the initial denial and ensured the operator’s reimbursement was protected.
Why It Matters
This legal win highlights FCC’s commitment to safeguarding the financial health of long-term care operators. By combining Medicaid expertise with persistent advocacy, FCC delivers results that reduce financial risk, strengthen reimbursement, and allow operators to focus on running their organizations with confidence.
