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What to do after your Medicaid application is denied

NAELA National Academy of Elder Law Attorneys, Inc. MEMBER

According to ThinkProgress, Medicaid boasts a 92 percent approval rate for insurance applicants. This bodes well for qualified people seeking coverage, but with tens of millions of Americans on the policy, the eight percent who are denied should not be overlooked. If you belong to this group, you are likely frustrated and seeking answers. There are several things you should keep in mind and do following a Medicaid denial. Follow these steps to seek recourse.

Understand the process

The first step to getting the coverage you need is understanding the Medicaid process. Every application is forwarded to the agency that administrates Medicaid benefits in your state. The state agency, though independent, must comply completely with the standards set by the federal Medicaid administration. When an application is denied, the decision must be made within the parameters of federal time limits and rules.

Determine the reasons

Though you may disagree with the stated reasons, you will need to identify the reason given for a denial of your application. In many cases, your income may be too high or your disability may not be recognized. Even more common, however, are simple errors in application paperwork that slow down the process and complicate things. These are troubling circumstances to encounter, but there may be ways to get coverage in spite of an initial denial.

Appeal the denial

Luckily, a denied application does not have to be the final word. Through the appeal process, you can fight to have the initial decision overturned so you get the coverage you need. The appeal will typically entail filing with your state's Medicaid agency and having a hearing with a judge. He or she will consider your appeal and recommend a final decision on your application to the state agency. This is usually called a fair hearing.

Seek retroactive coverage

If your Medicaid denial appeal is approved and you are granted coverage, you may be entitled to retroactive coverage. This means that applicants may have some of their prior medical costs reimbursed because of the initial denial that was overturned. You will likely need to petition for such benefits after gaining coverage, but doing so can alleviate a portion of the burden caused by your application's wrongful denial.

If you have had your Medicaid application denied, there is recourse available to correct the situation. You can learn more about some of the legal options you have by consulting with an attorney on filing an appeal.

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