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What do you know about Medicaid denials?

On Behalf of | Feb 9, 2022 | Medicaid Planning

As you or a loved one approaches your golden years, you may want to get a head-start on understanding Medicaid. Even if you submit an application, you may not receive approval.

The American Council on Aging explains common reasons for a Medicaid denial. Before submitting your application, understand what may trigger a denial.

Common denial reasons

Usually, applicants receive a denial letter because of their assets or income. Each state has limits on how much a person may have in income and assets to qualify for Medicaid. Those with too much may not qualify for benefits and receive a denial letter.

Sometimes, applicants qualify for Medicaid but must first complete a penalty period for infringing on the program’s look-back rule. If a Medicaid agent discovers an applicant gave away assets in a way that violates the look-back rule, she or he may deem the applicant ineligible to receive benefits for a specific period.

The third common reason for a denial is that an applicant does not have medical care needs that match the Medicaid assistance she or he desires. This reason represents the most infrequent scenario that triggers a denial.

Categories of denial

When applicants understand which denial type they receive, they may better create a strategy for appealing the decision. An applicant may receive a denial because she or he misread or misinterpreted the form and submitted the application with errors. Sometimes, Medicaid caseworkers make mistakes while helping clients, which may trigger a denial made in error. Even if a person receives a denial letter, she or he may make changes to become eligible.

Medicaid could help ease the financial stress of aging. By understanding how to submit an application, older adults may save themselves time.