Applying for Medicaid can be overwhelming. This process becomes more confusing and stressful if your application is denied and you don’t have additional financial resources to cover your medical bills. Thankfully, there are several options you can pursue to seek recourse for your denied Medicaid.
Understand the reason for the denial
You will receive a letter within 45 or 90 days stating why your application was denied. Some of the common reasons for Medicaid denial include:
- Exceeding the financial limits
- Having physical or functional needs that aren’t severe enough for an approval
- Making a mistake with your application
- Transferring assets less than their market value within five years of applying for the benefits
Options to pursue after a Medicaid denial
There are three options you can pursue if your Medicaid has been denied. You can request a reversal, re-apply, or appeal the denial. Here’s a detailed look at these options:
Request a reversal
Requesting a reversal means working with the caseworker rather than making an appeal. If you’ve made an error in the application process, you can contact a caseworker, mention how and where it was made, and provide the correct information. This process is fairly straightforward and often results in a reversed decision.
In some cases, your caseworker might be the one who incorrectly interpreted Medicaid’s rules or calculations. The best way to proceed when this occurs is to involve a Private Medicaid Planner. These professionals are best suited to reviewing your application and providing supporting documents illustrating the error without escalating the issue to a Medicaid supervisor.
When your application is denied, you can always re-apply. Sometimes, your reason for denial may be something as simple as failure to understand which assets should be considered. In this case, you can put part or all your income in a trust or spend down your assets to match the required limit.
You can also restructure your finances to meet the eligibility requirements. An attorney can help you determine which action best suits your situation.
Appeal the denial
The denial notice usually stipulates how long it takes to file an appeal, which can last up to 90 days. You should file your appeal in writing before the deadline. Once submitted, your Medicaid agency will set a hearing date. Failure to attend will have the case dismissed. Consulting with a legal professional can assist you in navigating this procedure.