A denial from Medicaid can be disheartening, especially if you’ve never received one. You might feel stuck with no hope of receiving Medicaid waiver services. Thankfully, there are steps you can take to ensure you’re getting fair consideration from Medicaid and can receive the benefits you’re entitled to. In this article, we’ll tell you what to do if you receive a denial from Medicaid.
Common Medicaid Denial Reasons
There will be times when it makes sense to fight a Medicaid denial and times when it doesn’t. You’ll need to know why Medicaid denies waiver applications to gauge this. Here are several of the most common Medicaid denial reasons.
Income Too High
There are income requirements attached to Medicaid waivers, and if your income is above the set threshold, your application will be denied. If your income is indeed too high to qualify for Medicaid, fighting the denial will likely be fruitless.
Note: Certain non-income eligible applicants may qualify for the spend-down program in Louisiana.
Health Condition Doesn’t Fit the Definition of a Disability
Medicaid waivers are only available to those with a qualifying disability. And by “qualifying disability,” we mean one that meets the criteria outlined in statute LA R.S. 28:451.2.
Medicaid Error
Everyone makes mistakes, Medicaid staff included. There could be information input errors, technical issues, missing documentation, miscommunication between internal agencies, and
other problems that prevent your application from being processed correctly.
What to Do After a Medicaid Application Denial
If you thought a Medicaid denial was the end of the road, you’d be glad to know that’s not necessarily the case. To ensure your case is fully and accurately reviewed, read on.
First, review your Medicaid denial letter. It will outline the next steps, including the appeal process. If you believe that Medicaid has denied your application in error, follow the appeal steps.
During the reconsideration process, Medicaid will review your application again to see if they made a mistake, misinterpreted your eligibility, or overlooked something that would have changed your eligibility status.
Before you send in your appeal, double-check the instructions on the letter and include any documentation outlined within. And be prepared to wait several weeks for Medicaid to complete their review.
Remember that time is of the essence when it comes to submitting appeals. Your denial paperwork will explain how long you have to appeal the decision made on your application. You don’t want to miss this deadline, or your appeal will be denied automatically.
Need Assistance with Your Louisiana Medicaid Waiver Application?
Sending in an appeal can get you access to the benefits you’ve been pursuing. But there’s no denying that the process can be convoluted, and you might have questions along the way. That’s where support coordinators come in. They can guide you through the Medicaid appeal process from start to finish and keep you at ease all the way through.
