Court rules guardians can appeal Department of Medicaid decisions without an attorney

April 9, 2014 / Medicaid

After losing at the state administrative level, Kimberly Forbes filed for court review of the decision regarding the level of services on her daughter’s Medicaid home and community services waiver. Rather than addressing the issues in the case, Medicaid’s lawyer, an assistant attorney general, asked the court to dismiss the appeal because the guardian was engaged in the unauthorized practice of law by bringing the case.

Disability Rights Ohio filed a brief as a friend of the court in Summit County Common Pleas Court in support of the guardian. Read the full text of the brief here [PDF].

In her brief, DRO attorney Alison McKay pointed out that both the Ohio guardianship statutes and the rules of practice in the Ohio courts require a guardian to pursue certain actions to protect the interests of the ward. They also allow a guardian to file court actions in the guardian’s name to protect the ward’s interests. DRO also said there is no precedent or support for the state’s argument, and as a practical matter there is no way that people who are indigent (and therefore eligible for Medicaid) could afford a lawyer in these types of cases, even if there were lawyers who had the expertise to do them.

The court decided that the guardian should be permitted to appeal to the court of common pleas on behalf of her daughter without having to retain an attorney to represent her daughter or herself. This appears to be the first time a court had decided this issue in Ohio. The court recognized that guardians of the person are responsible for authorizing the provision of medical benefits for their wards.

The court also recognized that the individual’s rights can be protected in cases in which the court reviews the entire record to determine whether the prior decision to deny benefits was correct. Thus, the court decided that in the limited circumstance of an administrative appeal challenging a decision of the Ohio Department of Medicaid to deny an individual’s request for a change in the level of Medicaid services, a guardian can bring the appeal on behalf of the ward without an attorney.

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