How to Respond to a Denied Medicaid Application

It may seem bleak if your Medicaid application for long-term care support is rejected. The ruling can be challenged, which is good news.

Medicaid has rigorous standards for income and assets because it is a programme for low-income people. The complex application procedure, which has numerous potential pitfalls, must be navigated to be eligible for Medicaid. A Medicaid denial does not guarantee that you will never qualify for assistance.

The Reapplication of Benefits

You could take steps to spend down your assets or put your income in a trust if your application was appropriately denied because you have too many assets or too much income. Contact a New Jersey Medicaid planning lawyer to determine the steps you can take to be eligible for benefits. After completing this, you can reapply for benefits. You should be aware that if you reapply for benefits, your eligibility date will be the new application date.

Reasons for denial of an application 

Several factors, including the following, may cause the Medicaid agency to reject a Medicaid application:

  • Documents not present. You must provide evidence that you are entitled to benefits, typically submitting Social Security documents, bank records, property deeds, retirement account statements, and insurance records, among other things.
  • Surplus resources A nursing home resident’s total “countable” assets cannot exceed $2,000 to be eligible for Medicaid payments (in most states).
  • Moved possessions. Transferring assets for less than market value in the five years before applying can result in a penalty term.

Within 45 days of the application, the Medicaid agency must issue a denial notification (or 90 days if the application is based on a disability). Carefully read the denial notice you receive. In addition to outlining the grounds for the application’s denial, the statement will also outline the appeals process.

You could make informal requests to the agency to overturn the judgement before submitting a formal appeal. This is the simplest and quickest course of action if you make an error on the application. A formal request or escalation to a supervisor might be necessary if the caseworker committed a mistake because it would be more complicated.

Contesting a judgement

You may find out how much time you have to file an appeal in the denial notice; it could be as little as 30 days or as much as 90 days following the denial notice. You must submit your appeal before the deadline.