Problems When Renewing Medicaid – Part 1

I have written a few times about the problem of keeping Medicaid once you have been approved.  There are a number of rules and regulations that – if violated – could cause the loss of benefits.  A recent case in our office illustrates another way that we haven’t previously experienced.

We applied for Medicaid for a married couple.  The application process was made more difficult because the caseworker did not understand some of the documents she was looking at and insisted on the production of other documents that did not exist.  As a result, our application was originally denied and I had to file an appeal before it was ultimately approved.

Under Medicaid’s asset rules for a married couple, the healthy (non-Medicaid) spouse is entitled to keep a certain portion of assets – what is known as the Community Spouse Resource Allowance or CSRA.  In our case that amount was calculated and we established that as of our requested Medicaid start date the combined assets of the couple had been spent down below that targeted amount.

Everything had turned out as we wanted and expected.  The problem we encountered, however, didn’t present itself until Medicaid’s annual redetermination.  As I have written about in the past, each year Medicaid checks in to see if you are still eligible for benefits.  While it is a much easier process than the original application, we are finding that the State has become more scrutinizing and restrictive in its application of the rules. Next week I’ll share the details