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Sunday, June 12, 2022

Why Are Medicaid Applications Denied?

Medicaid provides health care coverage for qualifying low-income residents in the U.S. While it is a federally mandated program, Medicaid is operated at the state level. With a comprehensive application process and stringent eligibility requirements, it can be frustrating to gain access to Medicaid benefits. This is unfortunate, especially when you consider how many people need access to the program for covering things like doctor visits and nursing home care. If you are hoping to access Medicaid benefits now or in the future, it may be beneficial for you to learn more about the common reasons Medicaid applications are denied in the hopes that you can avoid these pitfalls.

Why Are Medicaid Applications Denied?

Medicaid provides critical benefits for many Americans. In fact, many people plan to pay for long-term care through Medicaid. Having your Medicaid application approved, however, is much more difficult than some may realize. For starters, Medicaid applications are often denied because an applicant fails to meet Medicaid’s eligibility requirements.

While Medicaid is run by state governments, the federal government has guidelines in place to determine Medicaid eligibility. For starters, an applicant must be either a lawful permanent resident or a U.S. citizen. Furthermore, there are stringent income eligibility requirements for Medicaid. Income is, in reality, the primary eligibility factor. Eligibility will be determined based on an applicants Modified Adjusted Gross Income (MAGI) although some applicants, who are blind, disabled, or over 65 years old may be eligible without meeting MAGI income requirements. A common reason for Medicaid denial is that an applicant does not meet the income requirements.

An incomplete application or a failure to provide necessary documentation will also lead to a Medicaid application denial. In the past, there was more leeway in providing supplemental documentation and you may have been able to do so while your application was processing. Now, however, applications are quickly denied if you are not prompt at providing all required supplemental documentation along with your completed application.

Promptly responding to any Medicaid questions you receive is critical to your application’s success. Should Medicaid have any follow-up questions once your application is filed, they will send you a letter. You are required to respond to that letter within 10 days. The day clock starts on the day the letter is sent, not on the day you receive the letter. While an extension of time may be granted, it is best not to count on this. Being as prepared as possible prior to submitting your application can help you respond to such a letter in a timely manner and improve your chances of your application being approved.

Medicaid applications are also commonly denied based on incomplete or improperly executed physician’s statements. Your physician should complete the statement in full and then sign and date the document. Without all of this, your Medicaid application could be denied. To help ensure forms are completed and done so properly, Medicaid application should be sure to review all of these documents prior to submitting them to Medicaid.

Estate Planning Attorney

We know many come to rely on Medicaid to provide crucial coverage for long-term care expenses. If you need assistance with the Medicaid application process, reach out to the estate planning team at Monk Law for assistance. Contact Monk Law today.


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| Phone: 803-594-4453
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