What Happens When Your Medicaid Application is Denied?

Because Medicare and private health insurance do not cover long-term care,  Medicaid covers long-term care expenses for around 65% of people receiving long-term custodial care at home or in nursing facilities. Unfortunately, qualifying for Medicaid can be difficult. There are many reasons why your Medicaid application might be denied. You could be denied because you have too much income, your assets’ value is above the limit, or you don’t meet the non-financial eligibility requirements.

If your Medicaid application has been denied, there are some steps you can take to get coverage as soon as possible. Here’s more about what happens when your Medicaid application is denied:

Medicaid Ineligibility Period

When you apply for Medicaid, your caseworker will look at your finances and any financial transfers you made during the last 60 months. Those with assets and income above Medicaid’s limit will often spend down their assets by transferring them to family members. If your caseworker sees these types of transfers occurring during the lookback period, a penalty will be imposed. In Pennsylvania, for every $379.65 that was transferred during the lookback period (for 2024), one day of ineligibility will be imposed. This amount varies from state to state and is updated annually, but regardless, any money transferred during the lookback period could result in days or months of ineligibility. 

If you are already receiving long-term custodial care, the Medicaid ineligibility period could be devastating, which is why it is so important to speak with an elder law attorney as soon as possible to develop a strategy for spending down your assets in a way that complies with Medicaid’s eligibility requirements.

Appealing Your Medicaid Application Denial

If you or your Medicaid caseworker made a mistake during the application process, it may be possible to appeal your denial on these grounds. In most cases, you have 30 days to appeal your denial before having to reapply (and start over which means you could have a period of non-coverage).  If your appeal is successful, your benefits will take effect retroactively and cover any long-term care expenses incurred between the date of your application and your successful appeal.

Medicaid Asset Protection Attorney

The Medicaid application process is extremely complex, and most people aren’t equipped to handle it on their own. As you can see from the examples above, any mistakes in your Medicaid application could be financially devastating, especially for those who are applying while already receiving long-term care. If you want to ensure your application is successful, the best thing to do is speak to an elder law attorney well before you need care. With the assistance of an attorney specializing in elder law, you can develop a strategy to spend down and transfer your assets appropriately or do preplanning outside the 5-year lookback period.

If you need a Medicaid attorney serving Chester County, PA and surrounding counties, Robert Slutsky is one of the most experienced elder law attorneys in the state. Call (610) 940-0650 or visit our website to request a consultation!

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