Question:  The state has denied my mother’s request to receive long term care Medicaid benefits (Appealing Medicaid Denials).  Is there any way we can appeal this decision, and how would we go about doing this?

Answer:  You have the right to appeal the decision denying your mother’s Medicaid.  I cannot answer as to the exact procedures for any state other than Illinois. It is extremely important that you act immediately, because you generally have a very limited time in which to file your appeal. In Illinois, the Decision form which the State sends out has the specific instructions regarding the steps necessary to appeal the denial of benefits (Appealing Medicaid Denials).  I do not know if that is also true in your State, but I would think there would be some explanation with the decision.

I strongly recommend that you immediately hire an experienced Elder Law Attorney to represent your mother.  First the Attorney can evaluate the decision to see why benefits were denied. Frequently, when someone files an Application themselves or with the assistance of someone other than an Attorney, the application is completed incorrectly or insufficient information is provided to the State. In Illinois, the State will deny an application because it is incorrectly completed, does not contain the required back up documentation or you fail to provide the additional documentation the State requests within the time they give you, usually 10 days. These denials occur even though the applicant is entitled to Medicaid and would receive it if the application was done correctly (Appealing Medicaid Denials).

Obviously, denial may also be because your mother does not qualify for Medicaid or because she has made improper transfers of assets which cause her disqualification. An Elder Law Attorney can advise you whether the reason for the denial is appealable or whether there are additional steps necessary to protect your mother’s interests. It is imperative that you act immediately and I cannot emphasize enough the importance of hiring an experienced Elder Law Attorney.

James Siebert, Esq.
The Law Office of James C. Siebert & Associates
Arlington Heights, Illinois  60004

Appealing Medicaid Denials was last modified: November 15th, 2022 by James Siebert