Denial of Medicaid

What should you do if you are denied medicaid?


There is no requirement that you have an attorney to apply for Medicaid, and some people fill out their own applications. However, the Medicaid application form is lengthy and complex, and mistakes can be made when you are not familiar with the process. Unfortunately, these mistakes can be costly, if Medicaid benefits are denied or delayed.

There are a large variety of reasons why Medicaid applications are denied, for example, missing information, incorrect information or coding, failure to include required attachments, incorrect dates of service, or erroneous calculations.

Lamson & Cutner has an unbroken track record of success with the Medicaid applications that it has prepared and filed. Before taking the risk of doing it yourself, or hiring someone with inadequate knowledge or experience, you may wish to consider the consequences of a denied application.

A Fair Hearing

If your application or claim has been denied, your remedy is to seek to have the decision reversed in a Fair Hearing. The Fair Hearing is similar to a trial in a court, in that it is an adversary proceeding before an administrative law judge, where you will have an opportunity to present evidence to support your position. Of course, a representative of Medicaid will appear at the Fair Hearing to argue that the denial was correctly determined.

If Medicaid's denial is upheld, you will be back to "square one." If this happens, you will lose your original Medicaid "pick up date," which means that you will be personally liable to private pay nursing home bills, or the fees of home care providers, until your entitlement to benefits is established under a new, correctly-prepared application.

The Medicaid pick-up date under your new application could be many months later than the one established under your original application, making the delay an extremely costly one for you.

Lamson & Cutner can help if you find yourself in a difficult situation because Medicaid has denied your application or claim. The firm's experienced attorneys and staff know how to deal with these situations, and will represent you at the Fair Hearing. In some cases, we may even be able to get your original Medicaid application back on track, so that you can obtain the benefits and health care that you need.

If your Medicaid application has been denied, don't delay asking for help. Lamson & Cutner has assisted many clients with similar problems, and the firm will be pleased to assist you too.