AI Generated Opinion Summaries

This summary was computer-generated without any editorial revision. It is not official, has not been checked for accuracy, and is NOT citable.

Facts

• The case involves the appellant-petitioner's dissatisfaction with the installation of environmental modifications at his home by contractors under the management of his Managed Care Organization (MCO), UnitedHealthcare. The petitioner complained about the poor workmanship, including the installation of a different door than what was agreed upon, rude comments made by the contractors, and theft. UnitedHealthcare responded to the grievance but ultimately determined they had done all they could for the petitioner. The petitioner sought an administrative hearing from the New Mexico Human Services Department (HSD), which was denied.

Procedural History

• District Court of Santa Fe County: Affirmed the New Mexico Human Services Department’s denial of the petitioner’s request for an administrative hearing.

Parties' Submissions

• Appellant-Petitioner: Argued that federal and state regulations mandated HSD to provide an administrative hearing and that the denial of such a hearing violated his right to procedural due process.
• Appellee-Respondent: Contended that the petitioner's complaint constituted a grievance rather than an appeal under applicable regulations, and therefore, the petitioner was not entitled to an administrative hearing.

Legal Issues

• Whether the denial of the petitioner's request for an administrative hearing by HSD was contrary to applicable regulations.
• Whether the petitioner has a due process right to an administrative hearing.

Disposition

• The Court of Appeals affirmed the district court’s decision, agreeing with the denial of the petitioner’s request for an administrative hearing.

Reasons

• The Court of Appeals, with Judges Zachary A. Ives, Jacqueline R. Medina, and Megan P. Duffy concurring, found that the petitioner's complaint was properly classified as a grievance rather than an appeal, as no adverse action was taken against him by UnitedHealthcare. The court determined that the actions described by the petitioner did not constitute a denial, reduction, limited authorization, suspension, or termination of Medicaid benefits, which are necessary conditions for an appeal under the relevant regulations (paras 5-7). Furthermore, the court concluded that the petitioner did not establish a due process right to an administrative hearing, as his Medicaid benefits were not terminated or adversely affected in a manner that would trigger such a right under the precedents set by Goldberg v. Kelly and Mathews v. Eldridge (paras 10-11).