Another Medicaid Cautionary Tale – Part 3

In my blog post last week, I explained that John was unsuccessful in his attempts to obtain Medicaid benefits for his mom.  He then ended up being sued by the facility for the amount of unpaid bills which were not covered by Medicaid.  But why did his repeated attempts fail?

From my conversation with John it became readily apparent that he didn’t entirely understand the Medicaid process – how detailed and complex it is.  The first application he filed was denied.  I asked him the reason but he couldn’t recall.  It was clear, however that the level of detail overwhelmed him.  

John said he basically kept refiling the application at least 3 more times but he didn’t address the specific reasons for each denial.  It sounded as if he was almost taking a stab in the dark, hoping to hit on the solution.  That never works and so I completely understood why he failed each time.

What made the problem worse is that with each passing month, John said no one approached him about the unpaid bill so he assumed everything was fine – until he received the summons and complaint.

Finally, John asked me if he could appeal any of the denials.  Unfortunately, I told him that there is a strict 20 day time limit to file an appeal – referred to as a fair hearing.  By the time he reached out to us it was more than 20 days past the last denial.

In the end, the lesson to be learned is that the Medicaid process is a difficult, detailed and time consuming one and not to be taken lightly.  The risk of failure is being left with a large unpaid bill which family members may be responsible for depending on what they agreed to knowingly or unknowingly upon admission to the facility.