After waiting months for a Medicaid determination decision from your state, receiving a denial letter for a loved one who requires long-term care feels like adding insult to injury. The bad news is obviously that your loved one was denied the Medicaid benefits they desperately require. However, the good news is that in almost all cases, that denial can be reversed and turned into an approval. Whether the reversal is achieved by appeal, correction or by re-application is specific to the case and a decision that should be made by Medicaid experts.

In some cases, a denial is simply a mistake on behalf of the Medicaid office reviewing the application. In other cases, a mistake was made on the application. Still other denials are accurate because the applicant did not meet the strict financial requirements or the medical requirements.

The first step in reversing a Medicaid denial is to review the denial letter for the stated reason. This is followed by an in-depth review of the paperwork submitted with the Medicaid application. We analyze both for errors and omissions. Once we fully understand why the applicant’s state’s Medicaid office denied the application, we can formulate a plan to reverse it. There are many factors that go into this plan such as the applicant’s financial situation, their health, and any changes that have occurred since the initial application date. If married, their spouse’s wealth and health are also factored in the approach.

A denial can be corrected if a mistake was made. Appealed, if there is disagreement with the ruling or an applicant can re-apply at a later date having made the necessary financial arrangements to ensure that the applicant will not be denied a second time.

Our fees depend on the denial and the resulting approach we develop. Fees can be hourly, if we identify a simple mistake made by the Medicaid office or an omission by the applicant that will reverse the decision. More complicated cases that require extensive Medicaid financial planning are typically billed with a flat engagement fee.

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