Common Reasons Why Medicaid Denies Applications in New York

With the costs of medical care spiraling out of control, more and more elderly and disabled New Yorkers turn to Medicaid for coverage. Simply getting the application approved is a difficult battle by itself, however. If an application is denied for some reason, you could find yourself needing expensive nursing home care but having no funds available to cover the bill. Consulting a Brooklyn Medicaid planning attorney with a track record of successful Medicaid approvals should be your top priority, whether you are applying for yourself or helping an elderly loved one.

The application process is time-consuming and requires more work than many people first expect, especially if the Department of Health asks you to provide supplemental information. Ensuring the application is handled correctly is crucial to receiving benefits, which can be a life-or-death scenario for some clients who require round-the-clock Denied Medicaid Application Paperworkcare. The nursing home obviously doesn't want to find out that a bill for tens of thousands of dollars isn't going to be paid.

Preconditions for Benefits

As both a state and federal-run program, Medicaid has extremely specific preconditions for benefits like age, disability status, and monthly income. If you don't meet all the requirements, your benefits may be reduced, delayed, or denied altogether. Some of the most common problems applicants in New York deal with that lead to denied Medicaid benefits include:

  • Dealing with deadlines. Even though you may have to gather a wide range of information from your doctor, bank, and lawyer, there are still strict deadlines in providing documentation that are easy to miss.
  • Failing to meet income requirements. The low caps on income for Medicaid recipients often cause serious problems in areas with high costs of living like New York. In some cases, however, applicants can utilize the secondary Spend Down Program. If you qualify, this option allows you to pay in the difference between the income cap and your excess monthly income. 
  • Filing too early or too late. A lawyer can help you plan when to submit the application to maximize benefits. In situations where you must move to a nursing home immediately, Medicaid will provide back payments for up to 90 days. That means if you file too late, you could end up on the hook for part of the bill if benefits are approved after you are already a resident.
  • Mishandling assets. In an effort to meet the strict asset maximums, some applicants try to gift assets like cash or even a home to family members. Unfortunately, this plan doesn't work as Medicaid scrutinizes your last five years of financial activity. If you try to shift assets around improperly, your benefits may have a penalty period. However, there may be other options available depending on your circumstances, such as using trusts to retain access to spending money.
  • Missing documentation. Failing to completely fill out all forms in the initial application may cause an immediate rejection, but it's when additional information is requested that there's a serious chance for critical data to be misplaced. Your lawyer can help you properly document that you sent the required information within the time limits, and in some cases even use certified mail to prove the documents were received. 

What to Do If New York Medicaid Denies Your Application

Any of these problems may potentially delay when benefits actually kick in, or prompt the administrator overseeing your case to deny the application entirely. Don't panic if you are in that boat, however, because there are still options to resolve the situation.

With the help of a New York elder law attorney, you can provide the missing information or fix other mistakes. In some cases, you will need to actually file an appeal to the denial. Unfortunately, there's a limited time to have the decision reversed. That's why the best course of action is to consult an experienced Medicaid planning attorney before submitting your application. However, if you've already begun the process and received a denial, a lawyer can still help you get back on track by arguing your case in the appeal.

Let a professional take the guesswork out of the application process. Contact our Brooklyn long-term planning attorney today to set up an appointment and find out how we can help you get the benefits you deserve.

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Ted Alatsas
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Trusted Brooklyn, New York Family Law Attorney helping NY residents with Elder Law and Asset Protection