The Imperfect Medicaid Approval -Part 1

In this week’s blog post I return to the topic of Medicaid.  As I often tell people these days, Medicaid application are more challenging than they have ever been.  But even after we get our cases approved, rarely is there an instance in which the approval is a perfect one. There almost always is something about the approval that is wrong or needs to be modified.

For example, the cost share calculation may be incorrect.  Remember that the long term care Medicaid programs are designed with a cost share.  The recipient must give part of his or her income towards the cost of care, with the State picking up the rest.  In the case of a single applicant, there are limited amounts that can be kept from income to cover health insurance premiums and personal needs such as the cost of a cell phone or small personal items.

In the case of a married couple where only one spouse is receiving Medicaid benefits, there is a calculation to determine the amount of the Medicaid spouse’s income, if any, that the healthy spouse can keep.  This is known as a spousal allowance.  The healthy spouse’s income and certain housing expenses are factored into the calculation.  It is a somewhat convoluted calculation and easy for mistakes and miscalculations to occur.

As long as you are familiar enough with the ins and outs of Medicaid to recognize these errors, they can be easily corrected.  No appeal process is necessary.  Other mistakes, however, can only be corrected by filing an appeal of the initial decision.  This process is called a fair hearing and there is a strict deadline within which to file an appeal or forever waive your right to do so.

I’ll explain that next week.