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Filing a Medicaid Application? Better be Prepared for a Battle (Part 2)

In last week’s post, I started to tell you about what has been happening with increasing frequency to the Medicaid application process.  Denials have become almost routine and for reasons that range from flat out incorrect to the bizarre.

For example, last week we received a Medicaid denial for failure to provide a deed or lease for a residence in a town that the caseworker believes my client lived.  This request was never raised before and we never provided these documents for the simple reason that my client never lived in that town.   Two of the client’s children happen to live in that town and I suspect that is where the caseworker somehow picked up this information.

This type of request is actually not a first.  Last year, a Medicaid caseworker insisted my client owned a property she did not in fact own.  In that case, I was able to speak with the caseworker.  She had conducted a title search for property in the name of my client and her husband.  Their son had the same last name but was a “junior”.  She located a deed for property owned by the son and his wife, who had a different name than my client.  Nevertheless, she somehow considered that a potential asset of my client.  I was able to correct her misunderstanding before a denial was issued and we then received an approval of benefits.

Another common issue we are seeing is a denial of benefits for reason of being “overresourced”, which means having more than $2000 in assets on the last day of the month directly preceding the month we want Medicaid to start – what is known as the Medicaid pick up date.  This happens because typically checks written towards the end of a month do not clear until the next month.  Looking at the bank statement balance for the end of the month won’t reflect checks written and delivered the previous month unless those checks were actually deposited by the recipient and then presented to client’s bank for payment.

When I pay someone by check I have no control over when that person will deposit the check.  For that reason, Medicaid rules make clear that such checks are subtracted and counted towards the spend down to determine if the $2000 limit has been reached.  For many years, most caseworkers would routinely go thru that calculation and if they could not reach our conclusion, they would contact us.  Now, we are seeing more denials for being overresourced without any warning.

So, what happens when we get a denial?  It depends.  If the case has been processed quickly and we still have time to refile and request the same Medicaid start date, that usually has been the best approach.  However, since Medicaid rules only permit asking for benefits going back as far as 3 months from the date of the application, where it has taken 6 months, for example, to get a denial we must file an appeal – known as a fair hearing.  That is the only way to preserve eligibility for all the benefits we originally asked for.

We are then able to get a new person in the State’s fair hearing division to take a look.  That person typically has a better understanding of the specific rules and regulations and can then act as intermediary with the local office to correct the mistake.  Usually, the denial is withdrawn without the need for a hearing before a judge. The current pandemic and continued shutdown of most of the court system has unfortunately, delayed these fair hearings as well as the Medicaid application process in general in many counties.  It is, therefore, more important than ever to be prepared for a battle when filing a Medicaid application.  That means understanding the Medicaid rules and regulations – or working with someone who does – and having your ducks lined up – gathering together all the paperwork necessary to be filed and anticipating as many of the problem areas that can be expected to arise.