My Medicaid Application Was Denied. Now What?

Applying for Medicaid can be an overwhelming process. If your application is denied, this process can become even more stressful and confusing. Thankfully, there are actions you can take to become eligible for Medicaid even after a denial.

Medicaid is a federal program, but it is managed by the states. This means that each state has its own eligibility rules, including income and asset restrictions. To further complicate the issue, there are many different Medicaid programs, each with their own eligibility rules.

Medicaid applications can be denied for a variety of reasons, including the following:

1. Missing documentation. When you apply for Medicaid, you are required to submit a great deal of documentation in order to verify that you meet the financial qualifications for Medicaid. If you fail to provide the correct documentation, your application could be denied.
2. Excess resources. Medicaid has strict asset requirements – many programs state that you can only own $2,000 or less in countable assets. If you apply for Medicaid while owning too many assets, your application will likely be denied.
3. Asset transfers. If you transfer or give away assets within five years of applying for Medicaid, you could be penalized from becoming eligible for Medicaid benefits for several months, depending on the amount of the gift.

Because these rules are so complicated, is it recommended that anyone considering Medicaid seek the advice of an experienced attorney prior to applying. However, if you receive a denial notice after applying for Medicaid on your own, it is more important than ever that you consult an attorney. Many of the eligibility issues discussed above can be fixed, and an elder law attorney can come up with a plan to protect your assets so that you can be eligible for Medicaid even if you currently own too many assets.

Medicaid agencies are required to either approve or deny an application with 45 days of the application. If you receive a denial notice but you feel that you did meet the eligibility requirements for Medicaid, you are always permitted to appeal the decision. The denial notice will give you a deadline by which to file the appeal. Again, it is highly recommended that you hire an attorney to assist you with this process.

Once the appeal is submitted, the Medicaid agency will set a hearing date. At the hearing, you can call witnesses to testify and you can submit evidence as to why your application should have been granted. If your appeal is successful, you will get benefits retroactive to the date of your original application. If the first appeal is denied, you have several more opportunities to appeal, including having a court hearing.

Whether you are appealing a decision on your Medicaid application or attempting to correct an issue with the original application, it is crucial that you seek the advice of an elder law attorney. Medicaid rules and regulations are both complicated and ever-changing, so it is important to make sure you have an expert on your side to avoid a delay in getting the benefits you need.

ASK JOLENE

Hook Law Center: Jolene, what do you know about the cat who adopted a sphynx cat after it was rejected by its mother?

Jolene: This is a heartwarming story. In March, a sphynx kitten named Cleopatra was given to the Helen Woodward Animal Center after its mother rejected it. Staff had been bottle-feeding the baby, but six days later, a pregnant domestic short-haired cat named Ballerina arrived at the shelter and, after she gave birth three days later, welcomed Cleopatra as her fourth baby within minutes. Employees at the shelter were touched by Ballerina’s motherly instinct. She has even nursed the kitten herself. All five cats will soon be available for adoption.