Appealing a Denied Medicaid Application
Updated: Feb 21, 2019
If Medicaid denies your application, it must notify you in writing. Also, if you are already receiving benefits and Medicaid plans to reduce or limit your benefits, it must usually give you at least a ten day notice. The notice must contain the reasons for the change. If you disagree with a decision or action by Medicaid, you have the right to appeal. The following are examples of appealable issues:
Denial of eligibility
Termination of eligibility
Violation of your civil rights
Lack of timeliness of the Medicaid decision (e.g. award of eligibility, limit on payments for particular services, or issues concerning the amount of income Medicaid says you must contribute toward medical care)
To appeal, you must notify the county or state office in writing within thirty-three days of the effective date of the disputed action. If a timely appeal is filed, the law will give you the right to a fair hearing. If you request a hearing before the effective date of Medicaid’s proposed action, benefits must continue until a decision is reached after the hearing. Before the hearing, you have the right to see any information pertaining to the case. One of our attorneys can be very helpful at this stage.
The hearing should be held at a location convenient for you. If you are homebound or in a nursing home and cannot get to a hearing, the hearing can be held at your location. Alternatively, you may request to be present by telephone.
The hearing will be like an informal trial. An administrative law judge hears the case. You have the right to testify, to have others testify, and to cross-examine Medicaid’s witnesses. You should bring to the hearing all papers that relate to the case and be ready to explain the reason for appealing.
Medicaid must notify you in writing of its decision within ninety days of the day the hearing was requested. The notice should tell you how to appeal further if unsatisfied with the decision. You must appeal within ten days of receiving the decision from the hearing. If the decision is still negative at that level, you may seek judicial review in Circuit or Superior Court. At that stage, you will need a lawyer.