Article

The staff attorneys in the Office of General Counsel who serve as part-time Administrative Law Judges see two primary types of cases:

• Appeals of findings by the Division of Disability and Rehabilitative Services of failure to meet Medicaid level of care or denial of eligibility for Medicaid waiver funding for intellectually disabled individuals; and,
• Appeals of agency determinations adverse to Medicaid providers.

The purpose of the administrative appeal process is twofold: allow the adversely affected citizen a simple and fair appeal process; and, serve as a procedure allowing the Agency to review and analyze the decisions made in its name and ensure the decision was fully in line with Agency policy and the law. This latter goal cannot be met unless the ALJ analyzes the facts in a neutral and detached manner. Our ALJs take their role in the administrative appeal process very seriously, and objectively review the Agency’s actions to verify that the correct decision was made. The ALJs avoid communications with any party or representative without the other party being present. Decisions are made independently and without influence from coworkers or other agency personnel, and are based only on applicable law, policy, and facts in evidence.

The cases heard by ALJs in the OGC are governed by the Administrative Orders and Procedures Act, found in Indiana law at I.C. 4-21.5. Appeals not governed by AOPA, including appeals of Medicaid, SNAP or TANF eligibility determinations or Medicaid prior authorization denials, are handled by the Office of Hearings and Appeals.