OPTIMIZING MEDI-CAL REIMBURSEMENT

OPTIMIZING MEDI-CAL REIMBURSEMENT Orange County CAHF June 13, 2012 Robert H. Harvey, Esq. Sanders, Collins & Rehaste, LLP 5316 E. Chapman Avenue Orange, CA 92869 Direct: (714) 450-3898 rob@scrhealthlaw.com

Introduction Making the Initial Medi-Cal Application Completing the Application Process Determining Eligibility - Who Qualifies? Assessing the Share of Cost Trusts Evaluating Assets for Medi-Cal Eligibility Excess Money and Property Transferring Assets, Penalties, Deficit Reduction Act Implementing DRA provisions regarding citizenship or national status Medi-Cal Appeals

Introduction Medi-Cal is a shared Federal and State program providing financial support and health care assistance to Medically needy Californians who can qualify for benefits. Any person who is 65, blind or disabled and whose medical expenses are exhausting income and savings is very likely a candidate for medical financial assistance from the State. Each County administers its own Medi-Cal program and is responsible for screening applicants seeking benefits.

Making the Initial Medi-Cal Application

Q. Who can apply for Medi-Cal for a resident? A. Anyone who knows of the need of the resident for Medi-Cal may initiate the application process. However, if the resident is married, Medi-Cal may require the spouse to sign the application. If the resident has a courtappointed conservator, Medi-Cal will require the conservator to sign the application. Q. What is the simplest way to initiate the application process? A. Fill out the MC 210 Statement of Facts. The form is available at your local Medi-Cal office or online at: http://www.dhcs.ca.gov/services/medical/pages/medicalapplications.aspx. Under certain circumstances, the Statewide Automated Welfare System (SAWS 1) form may also suffice. The application is considered filed on the date that it is received and recorded at the DSS office. The date of filing is extremely important especially if the resident may need Medi-Cal coverage for services in prior months. The maximum amount of retroactive coverage is three months prior to the month of application. If retroactive coverage is needed, complete the MC210A Supplement to Statement of Facts for Retroactive Coverage

Q. It is the last working day of the month, and I am worried that I may not be able to get a full three months of retroactive Medi-Cal eligibility if I mail in the Medi-Cal application, what do I do? A. Consider hand-delivering the Medi-Cal application to the local Medi-Cal office and be sure to obtain a receipt that shows the date the application was initiated. Some Counties will allow you to submit an application by fax. Other Counties allow you to apply online through the CalWin system (http://www.benefitscalwin.org). Q. Do I have to be able to complete the Statement of Facts in order to register the application with the County? A. No. Register the application, then work with the eligibility worker on the completion of all the information. Q. Can the Medi-Cal office refuse to accept and register an application? A. No. Tell them that the application is for a nursing home resident who cannot physically come into the office, and that you are assisting the resident.

Q. Can the Medi-Cal office require a family member - and not a nursing home employee- to sign the Statement of Facts? A. Ordinarily, no. There is an exception if the resident is married or has a court appointed conservator. Q. What do I do if I am questioned about the mental capacity of the resident? A. The Eligibility Worker may ask you to provide proof of mental incapacity. A capacity letter from the treating physician or a History & Physical signed by the treating physician is sufficient proof of incapacity.

Who Should Complete the Medi-Cal Application? Threshold Issue: Is the resident competent? Who completes and signs the Medi-Cal application and who will ultimately complete the eligibility determination process turns on this question. Future appeals rights (discussed below) may depend on who signs the application. An incompetent resident should NOT sign the Medi- Cal application.

Who Should Complete the Medi- Cal Application?(Cont.) IF the Resident IS Competent: The resident and/or a responsible family member may complete the application. The Provider may wish to assist and remain involved in the application process. The MC 306 Appointment of Representative form will enable the County to communicate with personnel at the facility about a pending Medi-Cal case

Who Should Complete the Medi-Cal Application?(Cont.) If the Resident is Incompetent: Is there a spouse or court-appointed conservator? If so, they should sign the Medi-Cal application. The facility may assist a spouse with the eligibility process. If no spouse or conservator: Is there a responsible relative willing and able to assist with the application process? The facility can assist the family with the application process. The MC 306 Appointment of Representative form will enable the facility to do so.

If the Resident is incompetent and does not have a responsible relative who is able or willing to assist with the Medi-Cal application: The facility should apply for Medi-Cal on behalf of the incompetent resident. Personnel at the facility should sign the MC210 Statement of Facts as Person acting for applicant/beneficiary. For strategic reasons, the facility should consider applying on behalf of an incompetent resident if there is reason to believe that the family is uncooperative The eligibility determination will likely have to proceed by diligent search (discussed below)

The Eligibility Determination Process Needs Letters/Verification Requests: Two Contact Requirement 10-day minimum on deadline for verification requests Additional time may be granted for good cause. Notify the resident or the resident s family that the County Welfare Department will need to know the following: the resident s total monthly unearned and earned income. If the resident is married, evidence of the spouse s income will also be required. A list of the resident s liquid and other assets. Please note: assets over allowable resource limits must be spent down for Medi-Cal eligibility.

The Eligibility Determination Process Eligibility Determination Requirements The resident must disclose all major financial transactions that transpired in the past thirty months (look-back period). The County Welfare Department will ask how the money was spent.. Eligibility Month: The eligibility month is determined when the resident has financially met all the property resource and financial asset limitations according to State regulations. An applicant has until the last day of the eligibility month to spend his/her assets down to the allowable limits. See discussion of asset transfers, spend down of excess property and Deficit Reduction Act (DRA) below

The Eligibility Determination Process Verifications Required for Eligibility Determination: Income Social Security Private pensions Other income Property Bank accounts Real property Motor vehicles Other Healthcare Coverage Life Insurance Burial Policies

The Eligibility Determination Process If the Resident has Capacity: All verifications must be submitted for the resident and, if applicable, the spouse. The County has a duty to assist the applicant with the eligibility determination process If the resident s family or other representative has access to the bank statements, etc. you may be able to locate the needed records. However, if you cannot comply, and the resident is competent, the resident can sign a release of information form which will enable the eligibility worker to obtain the needed records.

The Eligibility Determination Process If the Resident does NOT have Capacity: If the incompetent resident has a responsible relative who has legal access to the verifications required, the relative must provide the requested verifications. If the resident does not have mental capacity and does not have a spouse, conservator or responsible family member to act on their behalf, the case will likely need to proceed by diligent search. If the responsible relative becomes uncooperative or is unable to legally access requested verifications the Eligibility Worker should be notified in writing and a diligent search requested

The Eligibility Determination Process Diligent Search: Where the resident cannot access the requested verifications because of mental incapacity and does not have a responsible party who can or will do so on their behalf, the County must take over the case and conduct a diligent search to determine eligibility. Diligent search procedures do NOT apply to spousal cases (unless the spouse is also incapacitated) Diligent search procedures enable the County itself to access the verifications needed to determine eligibility

The Eligibility Determination Process Uncooperative Family Members: The regulations setting forth the diligent search requirements and procedures make clear that the uncooperative actions of a family member cannot be imputed to an incompetent applicant residing in LTC These regulations do NOT apply to applicants with a spouse or conservator If a family member becomes uncooperative during the eligibility determination process, notify the Worker in writing If you know that the family is uncooperative at the outset of the application process, consider the Medi-Cal Intake Memo and do NOT have the family member sign the Statement of Facts

DETERMINING ELIGIBILITY Who Qualifies?

Determining Eligibility Who Qualifies for Medi-Cal benefits? Is the resident aged (65), blind or disabled? Is the resident a citizen? Citizenship or lawful residence are required for full scope LTC Medi-Cal benefits. Persons who cannot meet the citizenship/residence requirements may be restricted to coverage for emergency care only. See New Citizenship and Identity Requirements under Deficit Reduction Act discussed below Does the resident intend to reside permanently in California?

ASSESSING THE SHARE OF COST

How much income will Medical let the resident keep? The Department of Health Services uses formulas in determining how much the State will pay toward nursing home/medical bills, and how much the beneficiary will pay. The County assesses the monthly share of cost (SOC), which the provider is legally required to collect from the resident or the resident s Medi-Cal Agent. For a single LTC resident, Personal and Incidental Expenses are generally $35 per month, with few exceptions. Deductions or allowances can be made to a monthly share of cost for payment of any health or long term care insurance premiums or other life sustaining personal needs.

Assessing the Share of Cost Married Persons: Community Spouse Resource Allowance/Minimum Monthly Maintenance Need: A Medi-Cal nursing home patient can allocate his/her income to a spouse residing independently in the community. This is called the Minimum Monthly Maintenance Needs Allowance, MMMNA. The maximum income a nursing home resident can allocate to an at-home spouse changes annually. Any income in excess of the MMMNA limit must be paid to the nursing home as a monthly share of cost Spouses can allocate up to $2,841 (changes annually) of their income to the at-home spouse

Assessing the Share of Cost Unavailable Income: Under certain limited circumstances, you may be able to have the share of cost reduced based on the legal unavailability of the income Limited to cases where the resident is incompetent and does not have a spouse or conservator You must show that you have made reasonable efforts to gain control over the income: Public Guardian referral Attempt to redirect income Possible remedy If a family member has access to the income and is refusing to turn it over to pay the monthly SOC, though the ALJ decisions we have had have split on the issue.

EVALUATING ASSETS FOR MEDI-CAL ELIGIBILITY

EVALUATING ASSETS FOR MEDI-CAL ELIGIBILITY The State reviews countable, available, unavailable, and exempt property in granting Medi-Cal eligibility. What properties are exempt (not counted, not looked at, excluded, basically dismissed from County/State scrutiny), and what financial restrictions exist for some properties? How will the County evaluate the resident s financial status? What assets can the resident own and keep? What resources can be converted quickly to cash to pay nursing home bills?

EVALUATING ASSETS FOR MEDI- CAL ELIGIBILITY For general property limits, refer to the MC 007 Medi-Cal General Property Limitations information notice, which can be found online at: http://www.dhcs.ca.gov/formsandpubs/forms/forms/mc0 07infonotice.pdf CAVEAT: The rules governing property limits and exempt property are complex and possibly subject to change with the DRA in the near future

EVALUATING ASSETS FOR MEDI- CAL ELIGIBILITY General Property Limits: A single individual in LTC can have: Up to $2,000 in a bank account; Life insurance policies with a maximum total face value up to $1500; Irrevocable burial policies; One automobile Principal resident is exempt so long as there is subjective intent to return home; Married persons who have a spouse at home are subject to less restrictive property requirements under the Community Spouse Resource Allowance, which are intended to avoid impoverishing the at-home spouse in order to qualify the institutionalized spouse for Medi-Cal benefits

EXCESS PROPERTY

EXCESS MONEY AND PROPERTY Liquid assets must be spent down to meet allowable State limits by the last day of the applicant s eligibility month. Pay medical bills and/or other outstanding debts. Transfer up to $113,640 to a community spouse, a disabled/blind offspring or minor child living with a community spouse/legal guardian (no penalty imposed), if you are applying for long term care benefits.

Spend or convert excess money/property to other assets considered exempt by the State: Irrevocable Burial Trust for any amount of money; Certain Annuities; Clothing, TV, DVD Player; Encumber an account or pay a contractor in advance to repair a primary residence;

An automobile for a community spouse; Any item or service that fills a personal need; Pay rent, mortgage, property taxes in advance. NOTE: We do NOT recommend facility involvement in the spend down of excess property (except under Principe v. Belshe, discussed below). The regulations governing expenditure of excess property are complex and giving a resident the wrong advice can have adverse consequences

TRANSFERRING ASSETS THIRTY-MONTH LOOK-BACK PENALTIES

TRANSFERRING ASSETS - THIRTY-MONTH LOOK-BACK PENALTIES Applicants can jeopardize their eligibility for Medi-Cal if ownership in any nonexempt asset or property was transferred, given away or traded to another person or entity within the thirty-month look-back period preceding the application submission date. If any large expenditure occurred without benefit to the applicant or any property was transferred for less than fair market value, eligibility could be denied. During the imposed penalty period of ineligibility, a nursing home resident may appeal for restricted Medi-Cal benefits (pays for medical services, but not room and board). CAVEAT The changes mandated by the DRA have been signed into State Law. When these changes are implemented, these regulations will change.

PENALTIES: The appraised value for each occurring transfer is divided by a monthly penalty rate (the average nursing home private pay rate used by the County in calculating penalty months), resulting in the number of months an individual is ineligible for Medi-Cal benefits. FRAUDULENT TRANSFERS: If a resident transfers assets resulting in a penalty period and the nursing home is not paid for those months of service the nursing home may sue the resident (transferor) as well as the transferee if the transfer rendered the resident insolvent.

FORTHCOMING CHANGE MANDATED BY THE NEW DRA The Deficit Reduction Act (DRA) of 2005 changed Medicaid rules, and mandated that States administering the program make changes to comply with federal policy. The two most significant areas of change mandated by the DRA are changes to citizenship and identity requirements for eligibility and changes to the rules governing property. Some of the changes mandated by the DRA have been implemented by California and some changes are expected to be implemented in the near future.

FORTHCOMING CHANGE MANDATED BY THE NEW DRA California Senate Bill 483 includes the following changes to existing laws and regulations regarding Medi-Cal: Asset Transfers Home Equity Treatment of Annuities

ASSET TRANSFERS UNDER THE NEW DRA 60 Month Look-Back Period: existing regulations allow DHS to look back 30 months to ascertain whether an improper asset transfer was made. Once the new DRA changes are implemented, the look-back period will extend to 60 months. Ineligibility Period: under existing regulations, if an improper asset transfer is found to have occurred, the ineligibility period begins from the month of the date of transfer. This has often meant that penalty periods were imposed and completed before the individual entered LTC. However, under the new DRA rules, the start date for the penalty period is either (1) the first day of the month that the asset transfer occurred; or (2) the date the applicant would otherwise be eligible for long-term care Medi- Cal whichever is later! This means that penalty periods are now concurrent with the individual s likely inability to pay for care. Two Caveats: Possible Phase-In of Look-Back Period Undue Hardship Provisions

IMPLEMENTING DRA PROVISIONS REGARDING CITIZENSHIP OR NATIONAL STATUS

DHS All County Welfare Director s Letter dated June 4, 2007 Instructions for implementing the new requirements of the federal Deficit Reduction Act (DRA) of 2005. This letter specifically deals with DRA provisions related to documentation of U.S. citizenship or U.S. national status and identity as a condition of Medi-Cal eligibility for applicants and beneficiaries who declare that they are U.S. citizens or nationals.

Citizenship/Identity Requirements of the DRA Satisfactory documentation of citizenship/national status and identity must (with some exceptions) be obtained for: Medi-Cal applicants at the time of application; and Medi-Cal beneficiaries at the time of their next annual redetermination on or after June 4, 2007

Some citizens/nationals are exempt from the new evidence of citizenship and identity requirements, including: Supplemental Security Income (SSI) beneficiaries (current and former) Social Security Disability Insurance (SSDI Title II) beneficiaries Social Security Retirement and Survivors Insurance beneficiaries Medicare beneficiaries Exception: where an individual is entitled to Social Security survivor s benefits based on their spouse s SSN, they are not exempt from the citizenship/identity requirements

Citizenship/Identity Requirements of the DRA Individuals who have been determined to otherwise be eligible for Medi-Cal but are determined ineligible because they have failed to meet the citizenship/identity requirements within the reasonable opportunity period will receive the following restricted services: Medi-Cal long term care services Pregnancy related care Emergency services

Citizenship/Identity Requirements of the DRA These declared citizens who receive restricted Medi-Cal because they have failed to meet the citizenship/identity requirements within the reasonable opportunity period must still provide their valid Social Security number as a condition of eligibility. Providing documentation is a one time occurrence. All documents provided as evidence of citizenship and identity must either be originals or copies certified by the issuing agency. In California, counties will be able to request an automated match against CA birth records for individuals born in CA.

Medi-Cal Eligibility Recap and Provisional Medi-Cal Remedies

Medi-Cal Eligibility Recap The two most common reasons that Medi-Cal eligibility is denied are: Failure to provide verifications required to determine eligibility County assistance, release of information forms and diligent search procedures should enable you to overcome these requirements in most circumstances Excess property Spenddown of excess property, the unavailability regulations and the Principe v. Belshe remedy (discussed below) should enable you to overcome the property requirements in most circumstances

Medi-Cal Eligibility Recap Limitation on Retroactive Medi-Cal Coverage: You can only request 3 months retroactive benefits on a new Medi-Cal application Under certain limited circumstances, you may be able to either obtain additional retroactive benefits, beyond 3 months, or utilize provisional remedies to obtain additional coverage or reimbursement. They include: Appeal of the denial of an earlier Medi-Cal application or a discontinuance at the Annual Redetermination; or Provisional Remedies Craig v. Bonta, Principe v. Belshe or Hunt v. Kizer

Provisional Medi-Cal Remedies Craig v. Bonta: Applies to former SSI/SSP Recipients from and after July 1, 2002 Persons receiving supplemental social security income (SSI) combined with the state supplemental program (SSP) are automatically eligible for Medi-Cal benefits under the SSI application process. However, if any beneficiary enters long term care, there will be a discontinuance of SSI benefits and Medi-Cal. Beneficiaries in this situation will be evaluated for Medi-Cal eligibility under the medically needy program.

Provisional Medi-Cal Remedies Craig v. Bonta (Cont.): The Craig v. Bonta lawsuit mandated that there be no lapse in Medi-Cal coverage when a categorically-linked SSI/SSP Medi- Cal beneficiary terminates from SSI/SSP, unless and until a redetermination of their eligibility for County-based (LTC) Medi- Cal benefits is completed. Until recently, Counties were routinely failing to follow the appropriate Craig v. Bonta redetermination procedures Counties were routinely sending the Craig v. Bonta redetermination packets to the individual s home address even though these individuals, by definition, were no longer residing at home.

Provisional Medi-Cal Remedies Hunt v. Kizer: Court case allowing aging medical bills with current balances due to be submitted to the County eligibility worker for reduction in the applicant s monthly share of cost. Applicant receives a zero share of cost until all balances due are paid. Rather than establishing additional Medi-Cal eligibility, this remedy may be used to utilize monthly income to pay for prior months not covered by Medi- Cal.

Provisional Medi-Cal Remedies Principe v. Belshe: Utilized where Medi-Cal eligibility has been denied for excess property

MEDI-CAL APPEALS

MEDI-CAL APPEALS Fair Hearing The Medi-Cal program provides Medi-Cal applicants or beneficiaries with a right to appeal any action or inaction by a county welfare department relating to Medi-Cal eligibility or share of cost. These appeal rights are also available to Medi-Cal beneficiaries when medical services are terminated or reduced. This beneficiary appeal process is known as a fair hearing and is also referred to as a state hearing.

Notice of Action A county welfare department is required to notify Medi- Cal applicants or beneficiaries in writing of their Medi-Cal eligibility or ineligibility and of any changes made in their eligibility status or share of cost. This notice is called a Notice of Action (NOA). A Notice of Action from a county welfare department will contain information regarding the approval, denial or discontinuance of eligibility or the amount of (or change to) the share of cost and the effective date. The NOA will also inform the Medi-Cal applicant or beneficiary of his or her right to a state hearing if dissatisfied with the county welfare department s decision, and the procedures for requesting a hearing.

Notice of Action (Continued) Duplicate Notices of Action may be mailed to the administrator of a long-term care facility in which the applicant or beneficiary resides if the resident or his or her representative requests this be done.

The Medi-Cal Fair Hearing Process Questions and Answers

Measures to Take Before Filing a Request for Fair Hearing 1. Attempt to Resolve the Matter Short of Appeal: Discuss the case with the eligibility worker. Explain why you disagree with the county s action or inaction. If the eligibility worker is not persuaded by your position, listen carefully to the eligibility worker s rationale for the county welfare department s action. If you disagree with the eligibility worker, you can and should ask to speak with the Eligibility Supervisor. (Note: Unless a nursing facility representative completed the Statement of Facts, you will need to obtain written authorization from the resident or the resident s authorized representative or next of kin before the eligibility worker will discuss the case with you.)

2. Determine Who Will Represent the Resident at Fair Hearing: The Standing (i.e., legal right) to represent a resident at the hearing is a threshold issue. There are two ways the facility can have the standing to represent a resident: (1) Obtain written authorization from the resident or the resident s authorized representative or next of kin; or (2) The facility has the standing to act as the authorized representative if (a) the resident is incompetent; (b) the resident does not have a spouse, conservator or guardian to act on their behalf; and (c) the facility signed the Statement of Facts on the incompetent resident s behalf.

3. Review the case facts and assemble the evidence available to support your position. You are entitled to review the County case file If you are recognized as the Authorized Representative, you are entitled to access to any and all information, including regulations and evidence, needed to prepare for the hearing.

Q. How do you ask for a fair hearing? A. The best method is to complete the form on the reverse side of the Notice of Action and mail it to the address contained on the form. You can also request a fair hearing by telephone or via fax, as follows: Telephone: (800) 743-8525; Fax (916) 651-5210 Q. Do I have to have a notice of action to request a fair hearing? A. Generally, yes. However, an applicant or beneficiary has a right to a fair hearing concerning any action or inaction. If an applicant or beneficiary is dissatisfied with the county s inaction, there may not be a notice of action. (Example: You request a zero share of cost under Hunt v. Kizer and no written response is received from the county welfare department).

Timeliness of Medi-Cal Appeals Q. What is the deadline for requesting a fair hearing? A. Within 90 days from the date of the notice of action. However, if Medi-Cal benefits are being terminated or reduced, you must request a hearing before the effective date of the action (usually within 10 days of the notice), in order to continue to receive the same benefits until the hearing is held and a decision reached (aid paid pending). However, if the resident did not receive ADEQUATE NOTICE, the 90 days may not apply.

Q. What happens after I request a fair hearing? A. Usually, you will receive the following three documents: (1) acknowledgement of receipt of your fair hearing request; (2) correspondence from the appeals hearing specialist; and (3) notice of hearing time and date.

Q. What should I do when I receive correspondence from the appeals hearing specialist? A. You should contact the hearing specialist and discuss the case. Whenever possible, the hearing specialist will attempt to resolve the cases without resorting to a fair hearing. If the specialist determines that the county is in error on an eligibility determination, the county will reopen the case.

Q. What if I am asked to sign a conditional withdrawal? A. This means you are withdrawing your fair hearing request conditionally, i.e., so that the county can reopen the case. If after the case is reopened and reconsidered, you receive another eligibility denial, your right to a fair hearing has been preserved. Q. What if I cannot attend the hearing on the date and time set by the state? A. You can be granted one continuance for good cause. You should telephone the number on the notice of hearing prior to the date set for hearing and request a continuance.

Q. Is anyone allowed to attend the fair hearing besides the resident and/or the authorized representative? A. Yes. The resident or authorized representative may bring witnesses. If you are appealing an legibility determination, this could include a family member, a facility representative, or any person with information relevant to the case.

Q. Who can represent a competent resident at the fair hearing? A. The resident or any person whom the resident authorizes to act as authorized representative. Q. Who can represent an incompetent resident at the fair hearing? A. The following persons can be recognized as an authorized representative: (1) a relative of the resident; (2) an individual who has knowledge of the person s circumstances and has completed and signed the statement of facts (MC210) on the resident s behalf; or (3) an attorney (Judge s discretion).

Q. Does this mean a facility representative can be recognized as an authorized representative for an incompetent person? A. A facility representative can be recognized as an authorized representative if: (1) the resident does not have a conservator, guardian or executor; (2) the facility has completed the statement of facts; (3) the facility provided credible evidence that the resident is incompetent; or (4) the county does not contend that protective services are needed. If the county contends that protective services are needed, the county must establish that a referral has been made and accepted by the public guardian or other entity.

Q. Do I need to obtain information from the county before the hearing? A. Yes. The county representative prepares a position statement, outlining the case facts and the regulations applied in making its determination. The position statement must be available for review by the resident or authorized representative two days before the hearing, or you are entitled to a continuance of hearing. The procedure for obtaining the position statement may vary from county to county. You can ask that the position statement be sent to you via fax, but the county may require you to pick it up.

Q. How can I assist an incompetent resident with the eligibility and/or fair hearing process when there is no suitable family member? A. First review the notice of action. Why was eligibility denied? The most common reasons are: (1) failure to provide adequate information or documentation; (2) non-cooperation; or (3) excess property. Q. Should I prepare a position statement? A. You are not required to prepare a position statement, but if you have a complicated case or an uphill battle you should consider presenting a position statement or obtaining representation for the resident. You can inquire about free legal aid by calling the toll-free number on the reverse side of the notice of action.

Q. Can the hearing officer decline to recognize the facility representative as the authorized representative? A. Yes, the judge has the discretion to recognize (and therefore not recognize) someone as an authorized representative for an incompetent claimant. Q. Who is authorized to file a request for fair hearing on behalf of a deceased resident? A. If there is an estate, only the legal representative of the estate, i.e., executor or administrator, can be the claimant. If there is no estate executor or administrator, the representative may be the next of kin.

Q. What if a resident dies after a fair hearing has been requested? A. If a resident dies after a request for fair hearing has been filed but before a hearing has been held, the proceeding may only be continued by or on behalf of the representative of the claimant s estate. If there is no executor or administrator of the decedent s estate, the representative may be the next of kin.

Q. What if I am dissatisfied with the hearing officer s decision after the fair hearing? A. You have 30 days to request a reconsideration of the decision, but there are many restrictions. You can also file a petition in Superior Court, though costeffectiveness should be kept in mind.