If you apply for long-term care assistance through Medicaid and your application is denied, it may feel hopeless. The good news is that you have options to continue to seek benefits through the program.

Medicaid Eligibility

Medicaid is a program for low-income individuals, so it has strict income and asset eligibility requirements. Qualifying for Medicaid requires navigating the complicated application process, which has many potential stumbling blocks. For this reason, many applicants seek legal counsel to assist with filing their application and presenting their case for benefits.

Denied Application Reasons

A Medicaid denial does not mean you will not eventually qualify for benefits.  The Medicaid agency may deny a Medicaid application for a number of reasons, including the following:

  • Missing documentation. You need to show proof that you are eligible for benefits, which usually means providing Social Security statements, bank records, property deeds, retirement accounts, and insurance records, among other things. Often the agency will deny an application simply because copies of documentation provided to the agency are faint or were lost in their system.
  • Excess assets. In order to be eligible for Medicaid benefits a nursing home resident may have no more than $2,000 in “countable” assets.
  • Transferred assets. If you transferred assets for less than market value within five years before applying for benefits, you may be subject to a penalty period before you become eligible for benefits.

Denial Notice

The Medicaid agency is required to issue the notice within 45 days of the application (or 90 days if you filed for benefits on the basis of a disability). When you get a denial notice, read it carefully. The notice will explain why the application was denied and specify how to file an appeal.

Request Reversal of the Decision

Before filing a formal appeal, you can try informally asking the agency to reverse the decision. If you made a mistake on the application, this is the easiest and quickest way to proceed. If the caseworker made a mistake, it may be more complicated and require escalation to a supervisor or a formal appeal.  Keep in mind, however, that you have a deadline in which to file an appeal which will not be extended even if you are working with the agency to informally correct a decision.

Appealing a Decision

The denial notice will tell how long you have to file an appeal—the deadline may be as short as 30 days after the denial notice. It is important to file the appeal before the deadline. Whether the denial notice requires it or not, you should submit your request for an appeal in writing, so that there is a record of it.

Appeal Hearing

Once your appeal is submitted, the Medicaid agency will set a hearing date. Applicants must attend the hearing or their cases will be dismissed. You have a right to have witnesses testify at the hearing and to question the Medicaid agency’s witnesses. It is a good idea to have an attorney to help you through the appeal process. An attorney can make sure you have all the correct documentation and information to present at the hearing.

If you win the appeal, your benefits will be retroactive to the date of your eligibility—usually the date of your application. If you lose the appeal, the notice will explain how to appeal the decision. The next step in the appeal process usually involves submitting written arguments. If the next appeal is unsuccessful, then you will have to appeal to court. It is crucial to have the assistance of an attorney for this.

Reapplying for Benefits

If your application was denied correctly due to excess assets or income, there are steps you can take to spend down your assets or put your income in a trust. Contact the Stinson Law Firm at 317-622-8181 to find out what actions you can take to qualify for benefits. Once you do this, you can then reapply for benefits. You may also want to consider reapplying for benefits even if you believe the agency made a mistake on your first application and you have an appeal pending.  The second application gives you the opportunity to correct the mistake made on the first application and potentially obtain benefits prior to completion of the appeal process.  However, note that when you reapply for benefits, your eligibility date may change due to the date of the new application.

If you need assistance with your application for Medicaid benefits, contact the Stinson Law Firm today at 317-622-8181.

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