Filing a Medicaid Application? Better Be Prepared (Part 1)

Even before the current pandemic, getting a Medicaid application approved was increasingly challenging.  Now, with some government staff working remotely and many government offices short staffed because of social distancing requirements, it has not gotten better. 

What we are finding in our office is that applications that should clearly be approved are being denied.  In some cases, Medicaid rules are misapplied and regulations are ignored.  In other instances, procedural requirements are not being followed.  It is difficult to get a caseworker on the phone to talk about a case.  One county does not have any one person assigned to a case.  Different employees work on different aspects of each case.  Letters from that county do not contain the name of any person that we can call. 

Because filing a Medicaid application involves more than just the 16 page application, our filings typically include several hundred pages of documents or more.  That’s because the 5 year lookback requires that the applicant produce every statement for every account and investment owned within that time period.  Additionally, just about every Medicaid office is also requiring copies of every check written and deposited during that 60 month period.  This can easily result in 1000 pages of documents or more by the time the application process concludes. It is common for Medicaid caseworkers to tell us they never received what we sent them.  Often they claim in the denial that we did not provide a document that they never asked us for. 

Last week in two different cases we received denials for exactly these reasons.  Next week, I’ll tell you how we prepare for and resolve these denials.