After spending months completing a Medicaid long-term care application, and more months waiting for a response from the state, receiving a denial letter can feel like a slap in the face. The applicant surely needs the long-term care, and now they may have to pay for it out-of-pocket.
However, most Medicaid denials can be reversed and turned into an approval. How they get reversed depends on the applicant and their state of residence, and the process should be handled by Medicaid experts, like our team of professionals at Eldercare Resource Planning.
Some denials are the result of a simple mistake made while completing the application. In other cases, the state Medicaid officials made a mistake while they were reviewing the application that led to a denial. And some denials are legitimate because the applicant did not meet Medicaid’s eligibility requirements, which are strict.
The first step is to review the denial letter to find the reason for the denial. In some cases, the letter will make the reason clear. In other cases, the letter may be vague or lacking information. After analyzing the denial letter, we will review our client’s Medicaid application and all of the paperwork submitted with the application. During this process we will check to see if the state’s reason for denial is accurate, look for the reason if the denial letter was not clear, and make sure there are no other possible roadblocks to the application being accepted and our client receiving the long-term care they need. This includes a thorough examination of their financial and health situation, and the same for their spouse if they are married.
After reviewing all the material, we will formulate an exact plan to reverse the denial. If a simple mistake was made by the applicant or the state, an informal communication with the local Medicaid agency will usually lead to the denial being reversed. If the state ignores the informal communication or does not agree it made a mistake, our team will file an official appeal and request a fair hearing to reverse the denial. Our client can attend this meeting, but they are not required to since they have hired us to represent them. And in cases where the denial was legitimate, we will formulate a plan for our clients to reapply for Medicaid when they are eligible, and to pay for long-term care in the interim.
Our fees depend on the denial and the resulting plan to reverse the denial. If it was a simple mistake that caused the denial and reversing it will be a quick process, we will charge an hourly fee. More complicated cases that require extensive Medicaid planning and weeks or months of work are typically billed at flat rate that will be cost-effective for our clients.
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