Common Reasons for a Medicaid Denial
Updated: Mar 17
Applying for Medicaid can be complicated. While applications may seem straightforward, there are many hidden pitfalls where you could be denied Medicaid benefits or result in extensive delays being approved. Let’s take a look.
Income Is Too High
In most states, if you receive too much income from combined sources, you will be ineligible for Medicaid. Medicaid has strict limits, set by individual states, concerning how much money or income you can have in order to be eligible.
Approximately 75% of all Medicaid application denials are due to missing documentation. If an application is not complete, it can be rejected. In some instances, you may be asked to produce additional documentation. Failure to provide the required information in a timely and complete fashion will also result in a denial.
Some of the information that Medicaid requests includes bank statements and tax returns. Remember, when Medicaid is reviewing the applications, they are looking to make sure that you qualify for the program and that you are not receiving too much income or holding too many valuable assets.
While some states utilize electronic asset verification systems that obtain information from banking and financial institutions, a large majority of states are relying upon your submission of documents in order to determine if you are eligible for Medicaid. Failing to have a complete application or to respond to requests for supplemental information will lead to a denial.
Lost Applications and Supporting Documents
Believe it or not, one reason for denials that is more common than you might think - the people handling applications, from postal service employees all the way down to state Medicaid examiners, can lose parts of applications, documents, or misinterpret what was provided.
The people reviewing your applications are human and might make mistakes. When applications get shuffled from department to department, it is possible that some of the attachments get lost or that supporting documents cannot be traced back to the original application.
Copy and Track Your Documents
It is important when sending physical copies of your application and supporting documents that you do so in a manner that allows tracking of the shipment. As suggested by Gentreo, it is a good idea to provide a formal cover letter with your application listing all of the attachments that you are providing. The more organized and detailed your submission is, the better chance you have of it staying all together.
Additionally, if you are going to be clipping documents together, make sure that you use binder clips that hold them securely. Finally, always make copies of everything you send. This means even if you are sending a 2-inch stack of documents, make sure you have everything copied.
We at Gentreo suggest uploading copies of files or pictures of documents to your Gentreo Digital Vault where they will be stored safely and securely and readily available when you need them. This is why the Gentreo Digital Vault is so vital as losing documents and applications that took a lifetime to accumulate can all be lost in an instant if not saved properly.
Another reason why you made be denied is that the applicant transferred assets in an attempt to qualify for Medicaid benefits. The rules concerning assets and asset transfers are extremely strict. Even if you transferred assets to a family member as a meaningful gift of anything over $500, most states will impose mandatory ineligibility periods for every certain dollar amount transferred.
Five Year Lookback
Many people often say that the feds allow gifts of up to $14,000 which is correct for taxes, but not so for Medicaid. Medicaid generally reviews your financial records of the past 5 years to make sure that an asset transfer was not made in order to qualify for Medicaid. For example, if you gave a $75,000 gift to your friend 3 years before you applied for Medicaid, it is likely that you will be ineligible for Medicaid benefits for an extended period of time.
After your application is submitted, Medicaid might have additional questions or requests. The government typically conveys requests to the applicant in writing. Most letters require a ten-day response which runs from the date of the letter, not the date it was received.
Therefore, it is critical to stay organized and diligent during the application process. If you receive a request for additional information, make sure to respond immediately and track the delivery of any documentation you are providing.
Have a Checklist
For many people, Medicaid is an absolute necessity and not receiving the benefits can worsen an already dire situation. It is crucial not to do anything that could jeopardize or delay your application. Keep in mind that the primary reason for denial is missing documents, so make sure you have a checklist and copy everything.
For more information, contact us at Gentreo.com. We can help you create a simple and affordable health and estate plan, and a safe place to store it.
Gentreo is not a law firm or a substitute for a law firm, or attorney, or an attorney’s advice or recommendations.