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Medicaid: How To Appeal Denials

Reason for Denial: Not Eligible Financially

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You may be denied Medicaid because it is claimed that your resources and/or your income is/are too high to qualify. In these cases, an appeal is pretty cut and dry. It's an argument over numbers. If you can prove your numbers are right, you'll win. If not, Medicaid's numbers will win.

When looking for evidence to support your position, remember that in the absence of some pretty convincing proof, Medicaid's numbers are presumed to be correct.

NOTE: In states that cover people who are "Medically Needy," a mistake may not deny you eligibility for Medicaid, but it can inflate the amount you must pay out of your pocket for health care.

The most common reason for denial of Medicaid due to financial ineligibility is a misunderstanding of what is income and what are resources. Perhaps the way you reported something caused Medicaid to mistakenly call it income or resources when it was not. This could happen in several areas:

  • Free Rent: Sometimes benefits are denied because Medicaid claims that because you live rent-free, the value of your rent should be included in your income making your total income exceed the Medicaid minimum.

You will need proof that you are not living rent-free. For example, you can provide a written agreement that you are being loaned the money each month from the property's owner. If there is a loan, you must show the facts of a loan: the amount you are being loaned, a rate of interest and date on which the loan will be repaid.

It could be that you are loaned the rent each month and that the loan plus interest will be paid from the death benefit of the life insurance policy that is described in the agreement. (You can still obtain life insurance. See How to Obtain Life Insurance.)

  • Other in-kind or gift assistance: Many people think that unless they are given cash, it doesn't count as income. If you are denied Medicaid for this reason, review Supplemental Security Income to see if your gifts may be exempt.

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