Medicaid is one of the best benefit programs to provide health care and long-term care for the elderly; however, there are strict eligibility requirements that need to be met in order for a senior citizen in need to qualify for coverage. The sad truth is that many people who attempt to go through the Medicaid qualification process on their own get thrown off course by the confusing eligibility requirements, and it ultimately ends in a formal denial of benefits. The good news is that there are options available to appeal the denial decision and still qualify for Medicaid. First, we’ll take a look at the reasons why your Medicaid application could get denied, then examine the appeal process to see what your options are after a denial.
Why was my Medicaid application denied?
Medicaid applications typically require you to provide income and asset information to ensure you are under the financial limits imposed by the program. You will have to send them five years’ worth of bank statements, insurance policies, and other financial documents for them to examine. A Medicaid application is usually denied if the income and asset levels are either above the limit or if there were substantial financial or property transfers to family members within five years, which is known as the Medicaid lookback period. All of this information must be sent to Medicaid in a timely manner to keep up with the administration’s strict deadlines. Deadlines can be the sole cause of your Medicaid application denial, even if your income and asset levels are within the Medicaid eligibility requirements and you have only made qualified transfers.
What are my options after a Medicaid application denial?
You’ll find out the status of your application by either getting an acceptance notice with further instructions or a denial notice with instructions on how to appeal the ruling. The denial letter will also include the amount of time you have to respond in order to have your appeal heard. Keep in mind that this deadline is extremely important; if you miss it, your appeal and application will be automatically thrown out.
Once you move on to the appeals process, you’ll notice that a Medicaid appeal is similar to a court case. The appeal will be heard by the Florida State Medicaid Agency and adjudicated by a hearing officer, who acts much like a judge in a court case. If you approach the appeal as a court case, you’ll understand how important it is to have experienced representation to ensure your side of the case is fully heard and to have the best chance possible to have your application approved.
If you want to learn more about Medicaid applications or Medicaid denial appeals, or if you’d like to discuss your ongoing Medicaid application or appeal, please contact us at (813) 438-8503 to set up a complimentary consultation.