Medicaid, a federal and state program that provides health coverage benefits to many people, including senior citizens, covers basic health care costs and long-term care – care provided in nursing homes and assisted living facilities.

Many seniors rely on their Medicaid benefits for their long-term care. The prospect of having a Medicaid application denied can induce anxiety as loss of these benefits can be financially devastating.

Below are ten reasons your loved one’s application may be denied and steps to take to best ensure it doesn’t happen. 

1. Incomplete Application or Documents.

If you’ve ever applied for anything through a government agency, you’ve heard the refrain – Make sure to bring all your paperwork!  That’s certainly true for the Medicaid application which requires the submission of extensive documentation.

 Aside from providing proof of age, identity, marital status and citizenship, there are numerous financial documents necessary, including: bank statements, investment account statements, life insurance policy information, asset and other property information, tax returns and retirement income information. These documents are required to determine financial eligibility and are an essential part of the application.  Don’t leave home without them!

For a full checklist of required documentation, please refer to the Senior Planning website www.seniorplanning.com/document-checklist

2. Failing To Respond In A Timely Manner.

 Once the application is filed, make sure to be on top of your mailbox because if Medicaid has any questions, they’ll send a letter requiring a response within a specific deadline, and the deadline always begins from when they send it, not from when you receive it.  Sometimes Medicaid will permit extensions if you miss the deadline but that will delay receiving benefits, so best to avoid it if you can. 

3. Excessive Resources

It’s important to understand what your state Medicaid program considers “countable” resources before applying. For example, a large inheritance or investment may disqualify a senior.  

For more detailed information and explanation, please contact our specialists at Senior Planning Services at 1-855-S-Planning or via email at info@seniorplanning.com.

4. Filing Too Early

If you’re not financially eligible for Medicaid when you file, your application may be denied.

5. Filing Too Late

Medicaid only provides three months of retroactive coverage from the month you file the application.  Any costs incurred prior to that date won’t be covered.

 6. Medicaid Penalty Periods

If you plan on applying for Medicaid for a senior within the next five years, make sure that whatever they do, they do not gift money to family or friends during that time. Medicaid does not allow the transfer of assets for less than the fair market value during the 5 years prior to eligibility. Should a transfer of assets be uncovered, a penalty will be imposed. This penalty is a span of time of ineligibility for Medicaid benefits correlating to the amount of monies that were gifted.

7. Income Trust Isn’t Properly Funded

The following qualification applies to Specific States – If the senior is over income, make sure to establish a qualified income trust (QIT) account for her.  All money over the income cap must go through the trust, otherwise, the application may be denied. 

8. Not Clinically Eligible

To be deemed clinically eligible, the applicant must need help with at least 3 ADLs (activities of daily living – basic, routine activities that people generally perform without assistance. These include:  eating, dressing, bathing, toileting, walking and continence) and clinically requires assistance in the community/an assisted living facility.

If the applicant doesn’t need assistance with at least 3 ADLs, you may not qualify.

9. Not Financially Eligible

 An applicant must meet the Medicaid resource and income limits and guidelines set by their state. Resources and income above the state limits may disqualify the applicant.

For information about your Medicaid state guidelines, please contact our specialists at Senior Planning Services at 1-855-S-Planning or via email at info@seniorplanning.com.

10. Medicaid Erred

Even if you’ve followed the Medicaid guidelines to the tee, it’s still possible that Medicaid goofed. If, based on your research, you feel the application was wrongly disapproved, by all means, contest it.  Once you can prove it was Medicaid’s mistake, your loved one will receive their benefits.

Applying for Medicaid is complicated and often stressful.  Our experts at Senior Planning Services are here to minimize the stress and optimize your chances of eligibility.  Contact us at 1-855-S-Planning or via email at info@seniorplanning.com.