Nursing homes and other long-term care services can be costly — and possibly even unattainable for some individuals and their families. Many people apply for long-term care benefits through Medicaid. The Medicaid long-term care application process involves several important steps, including completing the application, providing supporting documentation, undergoing a health eligibility assessment, and going through a financial review to ensure you meet Medicaid’s income and asset limits.
However, after waiting months for the Medicaid office to review your application for long-term care benefits, you may be disappointed to learn that it was ultimately denied. If this is the case, where do you go from here?
The good news is that you still have some viable options. This article helps walk you through options for learning about Medicaid application issues with regard to denial for benefits and what you can do to rectify the situation so that you or your loved one receives coverage for the long-term care they need.
Was your long-term care Medicaid application denied?
If your long-term care Medicaid application or that of a loved one was denied, it can be extremely concerning, particularly if there are seemingly no other options for paying for necessary care.
A Medicaid denial notice typically arrives by mail. It will provide you with the reason or reasons coverage was denied, such as excess assets, missing information, missing documentation, or some other explanation for failure to meet the eligibility criteria for Medicaid benefits.
It is important to read the denial notice carefully so you can address any issues Medicaid provides. If you need additional verification or clarification, you can contact your state’s Medicaid office or caseworker directly.
If you or your loved one is already receiving services in a nursing home when the application for Medicaid benefits is denied, it is likely that you must pay out of pocket for care, which may involve using personal savings, income, or other assets to cover these expenses.
Steps to take after the denial of your Medicaid long-term care application
Following the denial of a long-term care coverage application through Medicaid, there are some steps you can take to help address the situation and possibly even reverse the decision to deny benefits. These steps may include:
- Reviewing the denial notice: The first step is to read over the denial notice carefully. Here, you will find information regarding the details of the denial as well as instructions on how to appeal Medicaid’s decision.
- Requesting a reversal: If the reason for the denial of Medicaid long-term care benefits was due to a mistake or missing information, you may request a reversal. You can do this by contacting your state’s Medicaid office and providing them with the necessary information.
- Filing an appeal: If you believe Medicaid made the denial decision incorrectly, you can also file an appeal. In this case, the denial notice lists instructions that outline how to do so as well as details on the deadline.
- Reapplying for benefits: If you file an appeal and it is unsuccessful, or if you need to correct any errors made on your Medicaid long-term care application, you may be able to reapply for benefits. In this instance, be sure that you address any of the issues that led to the initial denial of benefits. Also be sure to provide complete and accurate information on this second application.
- Seeking legal assistance: In some instances, it may be necessary to seek legal assistance. Consulting with an elder law attorney or a Medicaid planning specialist can be highly beneficial, as these individuals can guide you through the appeal process. In addition, they can help you ensure that all the necessary documentation is in order for a follow-up application and represent you at any hearings if necessary.
It is critical to act promptly and follow all the instructions in the Medicaid long-term care benefits denial notice. If your appeal or resubmittal of the Medicaid application results in approval, you will be enrolled in the Medicaid program, and your state will coordinate with the nursing home or care provider to begin payments for the eligible services you receive.
Alternative options for paying for long-term care
If you have explored all the above options and are still unable to obtain Medicaid long-term care benefits, it may be necessary to explore alternative options for paying for nursing home care or another type of long-term care.
Depending on your or your loved one’s situation, other possible resources could include:
Navigating the Medicaid application process can be complex and often overwhelming. Because of that, talking over your situation with a professional who is well-versed in Medicaid’s long-term care coverage and application process is highly recommended. Doing so can better ensure that all paperwork is properly completed and submitted and that you avoid potential issues with your application.
