Scott Silverberg Wins Medicaid Coverage Appeal

By Stephen J. Silverberg
New York Elder Law Attorney

I’ve been practicing elder law for many decades, but there’s always something new and unexpected in any area of the law. Here, it was a decision in a Medicaid coverage matter skillfully handled by Scott Silverberg, an associate at the firm and also my son. It was a great reflection on the firm, and an important win for our client.

We filed a Medicaid application for a client, and it was denied, allegedly because our client did not provide the requested documentation. Part of applying for Medicaid, and why clients are rightfully worried about doing this on their own; people who meet the eligibility requirements have their applications denied due to bureaucratic snafus. Here, the caseworker maintained our client did not provide the correct documentation.

Scott demonstrated we had validly requested an extension of time to submit the requested additional documents and our client timely complied with the request.

The missing part of the puzzle was the automated notice from the Agency. The deferral notice from the agency arrived one day before the due date. Even if the documents were sent immediately, once the Agency receives the documents it takes a week to ten days to route the documents to the caseworker.

The agency submitted a return deferral document at the hearing. We did better.

Scott Silverberg skillfully and tactfully established that she had complied with the request for information and asked for an extension for more information. The administrative law judge’s written decision reversed the denial and approved the client’s Medicaid application. Here is my favorite part of the decision:

The lawyer’s testimony was found to be credible because of [his] demeanor, responsiveness to questioning, and because the Appellant’s testimony was plausible and believable.

We can only guess on what was behind the lack of professionalism by the caseworker assigned to this client’s file. There were also hints the Agency sent the notice to the incorrect address, and that may have further delayed this case.

The best part for me as an attorney and admittedly, as a parent, is that the issue came down to the caseworker’s word against Scott’s, and his professionalism and demeanor was a key reason the judge reversed the denial.

About the Author
Stephen J. Silverberg is nationally recognized as a leader in the areas of estate planning, estate administration, asset preservation planning, and elder law. He is a past president of the prestigious National Academy of Elder Law Attorneys (NAELA), and a founding member and past president of the New York State chapter of NAELA.