Medicaid is a program that assists with lower-income individuals, so there are certain requirements that must be met. Qualifying for Medicaid can be a complicated process that is often better to have a lawyer prepare for you. Having it denied does not mean the end. 

     There are a number of reasons as to why a Medicaid agency would deny a claim, reason for a denial could be:

• Excess assets- In order to qualify for Medicaid in most states one must not have more than $2,000 in countable assets in most states.
• Missing documentation- Proof is needed to show that you are eligible. This requires many different documents. Absence of any necessary documents will often lead to a denial.
• Transferred assets- If you have transferred assets for less than market value in the last 5 years, then you may be subjected to a penalty period before you can become eligible for benefits.

     The agency dealing with your Medicaid has 45 days to issue a denial notice (or 90 days if applying for disability reasons). Make sure to keep and read the denial notice. It will tell you specifically why you got denied, and how to appeal it. 

     Before filing for a formal appeal, you can informally request the Medicaid service to reverse the decision. This is the easiest way to do it if you were to have made a mistake on the application. If the caseworker made a mistake then it may be easier to file a formal appeal.  

Appealing a decision

     The denial notice will tell you how long you have to file an appeal. You will usually have between 30-90 days after the notice. Make sure to do this before the deadline and request the denial in writing so that there is a record of it. 

     Once you submit an appeal, the Medicaid agency will set a hearing date. If you do not attend then your case is automatically dismissed. You have the right to have witnesses testify at the hearing and to question the Medicaid agency’s witnesses. It is often a good idea to seek the assistance of an attorney. They will make sure to have all the correct documentation and all information necessary for the hearing. 

     If you are to win the appeal then your benefits will be retroactive to the date of your application. If you lose, the notice will explain how to appeal the decision. The next step usually requires submitting written arguments. If this is unsuccessful then it will have to be appealed in court. An attorney is needed for this.

Reapplying for benefits

     If your application was denied for excess assets or income, then you can spend down assets or put them in a trust. Contact your local elder law attorney to find out the best way to protect yourself. They will make sure that you have the best plan of action for your future.