Reasons Medicaid Applications are Delayed or Denied

It can be difficult to obtain quality healthcare at an affordable rate. Fortunately, there are programs in place to assist. Medicaid is a federal and state program that helps provide healthcare to individuals with limited resources and income. The application and approval process can end up being quite complicated and time-consuming, though, leaving individuals without health coverage for extended periods of time. Understanding the most common reasons for delays and denials will hopefully help you avoid this and obtain Medicaid benefits as soon as possible.

Too Much Income to Qualify for Medicaid

To qualify for regular Medicaid in California, you must not exceed a certain income cap (unless you qualify through different requirements unrelated to income). As of 2022, the limit is $1,564 per month if you are applying as a single person. If you are applying with a spouse, your income cannot exceed $2,106 per month. If you make more than this and applied for Medicaid, this is likely the reasons your application has been denied or delayed.

Income is broadly defined, including wages earned through employment, alimony payments, pension, any type of social security income, withdraws from an IRA, and stock dividends.

Too Many Assets to Qualify for Medicaid

In addition to income limits, Medicaid also puts a limit on the amount of assets you are permitted to have and still qualify for Medicaid. Assets include cash, funds in a bank account, real estate that is not your primary home, and some vehicles, among other things.

As of July 1, 2022, the asset limit has been increased, allowing individuals and couples with more assets to qualify for Medicaid in California. To qualify for Medicaid in California, you can have up to $130,000 in non-exempt assets if you’re single and $195,000 if you’re married.

If you’re unsure about the value of your assets or if something is considered an asset – exempt or non-exempt – speak with an experienced lawyer right away.

Missing Documentation or Incomplete/Incorrect Application

Every year, a significant number of Medicaid applications are delayed or denied because the application has been completed incorrectly or required documentation is missing. In some circumstances, the office might contact you and ask you for the documentation or inform you that the application is incomplete or was filled out incorrectly. Other times, though, they will simply deny your application.

Medicaid Error

In many cases, Medicaid applications are actually denied in error. When you receive your denial letter, it should outline the reasons for the denial. You should review this thoroughly and compare it with your application to see if the reasons for denial are legitimate. It’s advisable to do this with an attorney.

When applying for Medicaid, you should always keep copies of your application and the documents you submit for your own records. If you receive a denial letter, you can then review it while looking through the application and the supplemental information you submitted with your application.

You Can Appeal a Denial

If your Medicaid application was denied, you still have options: you can file an appeal. While an attorney isn’t required to do this, it’s a good idea to speak with one, as there are deadlines that must be followed and complications that you may not anticipate.

If you believe you’re eligible for Medicaid but your application was denied or is significantly delayed, it’s a good idea to speak with a lawyer as soon as possible. A mistake may have been made, or we may be able to help you plan and meet eligibility requirements. Contact us today to schedule a free consultation.