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Medicaid: What to do if your claim is denied

Many Americans need to apply for long term care through Medicaid, and end up dealing with a denied claim.

Medicaid benefits notebook

While it may seem like a lost cause, you can still appeal that decision.

Medicaid is used for low income Americans as long as they meet eligibility requirements.

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Why your Medicaid claim could have been denied

One reason you may have been denied is because you did not provide adequate documentation.

This includes Social Security statements, bank statements, property papers, retirement and insurance records.

If you have over $2,000 in countable assets you could be denied.

What are the Medicaid income limits?

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You may be penalized for transferring assets for less than market value within 5 years of applying.

If denied, you’ll be notified within 45 days.

You’ll see in the letter why you were denied with clear appeal instructions.

You may ask for a reversal on the decision first in case it was a simple mistake that had you denied.

If the mistake was on their end, you’ll need to formally file for an appeal.

How to file an appeal for Medicaid

You must read carefully to see exactly how many days you have before you run out of time to file.

You should submit it in writing to keep a record.

You’ll be issued a hearing date following the appeal.

If you fail to appear, your appeal may be dismissed.

Seeking out an attorney could be helpful.

If you win the appeal, the benefits will go back and cover the dates you weren’t covered after applying.

If you lose, you’ll be given instructions on how to file another appeal.

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