A 2022 Appeals Court decision in a Washtenaw County case restored a favorable ruling in an administrative hearing to a DD adult.

FYI: (This case was decided in February 2022.) The guardian of a DD adult requested an administrative hearing to determine whether an increase in the adult's budget from CMH was necessary to allow him to achieve his goals written in an Individual Plan of Service. Ultimately, an administrative law judge in an appeals hearing sided with the adult with DD and his guardian. WCCMH appealed the decision to the Circuit Court. It turns out the law says that the administrative law decision is final and WCCMH had no right to appeal the decision. Here is a summary and explanation of the case from the Website of Disability Rights Michigan.

Wiesner: Making sure that when Michigan Medicaid recipients win administrative appeals, the win is final.

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. [emphasis added]

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.

Details

March 2019
Mr. Wiesner requests an increased budget from Washtenaw County CMH (WCCMH), to achieve the goals in his individual plan of service (IPOS). WCCMH denied the request. Mr. Wiesner would later request an internal appeal.

July 2019
After the internal appeal, WCCMH upholds its own denial of Mr. Wiesner’s requested budget increase.

November 2019
Mr. Wiesner appeals WCCMH’s internal appeal decision to the administrative court.

January 2020
The Administrative Law Judge rules in favor of Mr. Wiesner, finding that his budget is not enough to achieve the goals in his IPOS.

May 2020
WCCMH appeals the ALJ’s decision in favor of Mr. Wiesner to the Circuit Court.

November 2020
Circuit Court denies Mr. Wiesner’s arguments that WCCMH has no right to appeal the ALJ’s decision and reverses the ALJ’s decision.

March 2021
The Michigan Court of Appeals grants Mr. Wiesner leave (gives him permission) to appeal the Circuit Court’s order.

April 2021
Mr. Wiesner appeals the Circuit Court’s decision to the Michigan Court of Appeals.

February 2022
The Michigan Court of Appeals reverses the Circuit Court and reinstates the ALJ’s decision, holding that WCCMH has no right to appeal the ALJ’s decision.