Wiesner

Case Status: Resolved

Case Filed: March 2019

Main Concern

Under federal Medicaid law, Medicaid recipients have the right to challenge decisions made by the state Medicaid agency and its contractual agents, like local community mental health organizations (CMHs).

These challenges come in the form of administrative appeals. The concern in this case was that the recipient won his administrative appeal, but the CMH then appealed the favorable hearing decision to a judicial court.

Summary

Kevin Wiesner receives services from Washtenaw County CMH (WCCMH). In 2019, Mr. Wiesner’s guardian told WCCMH the budget given for his services was not enough to do what those services were supposed to according to Mr. Wiesner’s individual plan of service (IPOS). Mr. Wiesner’s guardian asked for more money, which WCCMH denied. Mr. Wiesner appealed that decision, and an administrative law judge (ALJ) found Mr. Wiesner was right: his budget was indeed insufficient.

WCCMH then appealed that decision to the Washtenaw County Circuit Court, even though, WCCMH is a contractual agent of the Michigan Department of Health and Human Services (MDHHS), and ALJ decisions are the final decisions of MDHHS. The Circuit Court reversed the ALJ’s decision. Mr. Wiesner then appealed from the Circuit Court to the Michigan Court of Appeals, which held that Medicaid agencies like WCCMH do not have the right to appeal ALJ decisions. This reinstated the ALJ’s decision.

Outcome

The Michigan Court of Appeals held in a published decision that Medicaid agencies (MDHHS and its contractual agents) do not have the right to appeal ALJ decisions, because ALJ decisions are the final decision of MDHHS. This reinstated the ALJ’s decision in favor of Mr. Wiesner.