A Medicaid application can be denied for various reasons. While a denial notice may have left you feeling pessimistic, you have the right to appeal the denial. Many times, Medicaid applications will be denied because of simple mistakes, such as missing documentation, and this can be easily fixed. Common Medicaid application denial reasons include:
- Too much money or too many assets
- Your income is too high
- A trust you set up does not comply with Medicaid eligibility rules
- You filed too early
- The physician’s statement is not completed properly
- You failed to quickly respond to follow-up questions
The Denial Notice
In order for the denial of your Medicaid application to be lawful, the notice must adhere to proper notice requirements. First, the notice must be written. If a caseworker told you over the phone that your Medicaid application was denied, that is not enough. Second, Medicaid must send you the notice within 90 days from the date of your application, if you applied to Medicaid based on a disability, and 45 days for any other basis.
The notice itself must contain the reason as to why your Medicaid application was denied by providing specific state laws to back up their assertion. Additionally, the notice must also tell you that you have the right to appeal the denial, how to request the hearing, and that you may represent yourself, hire an attorney, or appoint a spokesperson to assist you. There will also be an appeal deadline listed within the denial notice. This is the most important information that the denial notice will include. If you have no justification for appealing late, your appeal will be denied.
The Appeals Process
The first step to appealing the denial is to request a hearing. In New York, the request must be made in writing, but it does not have to state much more than “I request an appeal to the denial notice dated XX/XX/XXXX.” You will want to try to submit the request in person at the local state Medicaid agency office if possible and get the notice date stamped. This way, the office will be unable to state that your appeal request was too late.
Once the appeal is approved, you will be granted a fair hearing. It is important to show up to the hearing, either in person or by phone, or you will risk having your appeal dismissed. If you missed the hearing, you will have the opportunity to show good cause as to get the dismissal reversed. Good cause means medical emergency or a broken-down car, it will not be enough to state that you simply forgot about the hearing.
Before the hearing takes place, you will want to review all documents in your file in order to understand exactly why your application was denied. You have the right to provide additional documentation or even provide witnesses if necessary. If the Medicaid agency representative states that you are missing documents that you did not bring with you, but you know you can provide those documents to the agency, you may ask the hearing officer to give you additional time to collect the documentation necessary before they may their decision.
Furthermore, your application may have been denied because the agency did not think you were disabled. If that is the case, the judge will order another medical exam for you, and you will be required to submit and attend the additional medical exam. The state will be responsible for paying for the medical exams and any additional tests it may order.
After the Hearing
After the hearing has been completed, you will again receive a written notice of the decision. If benefits are denied, the notice will again inform you of how you may appeal the decision. This additional appeal will not include a hearing and you will only be able to provide written arguments. If benefits are then granted, your Medicaid coverage will become effective from the date you first filed the application. Therefore, it is important to keep copies of any medical expense documentation as well as any prior applications, denial notices, and appeal requests.
For those seeking assistance with Medicaid applications, P&P Medicaid can handle the entire application and document acquiring process and appear on the applicant’s behalf for all interviews and appeals with Medicaid. For more information about the Medicaid application process, any of our other services, or to schedule a consultation, contact our Long Island Medicaid application professionals at (516) 541-4770 or fill out our contact form.