My long-term Medicaid claim has been denied. What do I do?

On Behalf of | Feb 22, 2023 | Medicaid Planning And Asset Protection |

The process of applying for long-term care through Medicaid can be overwhelming. And if your claim is denied, the experience can become even more stressful and devastating. Fortunately, a denied Medicaid is never the end of the road for you. 

You can appeal a denied Medicaid claim. Before you do so, however, it helps to start by understanding why your claim could have been denied in the first place. 

What is Medicaid, and how does it work?

Basically, Medicaid is a joint federal and state insurance program that provides healthcare coverage for qualified individuals. While the federal government sets the rules and contributes almost 50 percent of the funding, each state is responsible for its own Medicaid program.  This means that each state stipulates its own eligibility rules, including income requirements. 

Qualifying for Medicaid

Medicaid is designed for low-income individuals. Thus, to qualify for the program, you need to meet strict asset eligibility requirements. Here are some of the reasons why your Medicaid application can end in denial:

  • Missing documentation: You need to prove your eligibility for Medicaid, and this usually means providing your Social Security statements, property deeds, bank records, insurance records and retirement accounts among other relevant documentation.
  • Exceeding the income threshold: Your “countable assets” must not be worth more than $2,000
  • Transferred assets: Finally, if you transfer assets for less than market value within the last five years, then you may be subject to penalties before becoming eligible for Medicaid.

You can appeal a denied Medicaid claim. Usually, the denial notice will inform you how much time you have to file a denial. And this can range from 30 to 90 days. It is important that you file your appeal in writing before the appeal deadline runs out. 

Protecting your rights

A denied Medicaid claim can be frustrating. The good news, however, is that you can appeal the decision. Experienced legal guidance is wise.