Case of Nina Kaptchuk v. Director of the Office of Medicaid Shows that MassHealth Fair Hearing Appeals Should Not Be Treated Lightly

by: Brian E. Barreira, Esq.

In the 2013 Massachusetts Appeals Court case of Kaptchuk v. Director of Office of Medicaid, a MassHealth denial was upheld. An application for MassHealth benefits for Nina Kaptchuk had been denied due to “disqualifying transfers.” A “fair hearing” had been requested, and the denial was not overturned. A so-called 30A appeal was filed with the Superior Court, and the judge there did not overturn the denial. On this further appeal to the Massachusetts Appeals Court, the denial remained in effect.

The Superior Court and the Massachusetts Appeals Court only reviewed the facts presented at the fair hearing to see if the hearing officer analyzed the facts fairly. Unfortunately, new or better facts cannot be presented after a fair hearing. The Massachusetts Appeals Court suggested that the preparation for the fair hearing was inadequate. Transfers to or for the benefit of a disabled person can be treated as non-disqualifying, but the lawyer handling the appeal apparently did not introduce evidence proving that the daughter who received amounts of money from Nina Kaptchuk was mentally ill.

The point that should be taken from this case: Do not treat any fair hearing lightly. Any point you want to make should be proven from every possible angle, and do not presume common sense. Most especially, do not assume that you will get another chance to explain the facts as you see them.

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