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Why Would Medicaid Be Denied? An Experienced Orlando, Florida Medicaid Lawyer Shares 7 Reasons Why

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Why Would Medicaid Be Denied? An Experienced Orlando, Florida Medicaid Lawyer Shares 7 Reasons Why

August 15, 2023
Geoff Hoatson

Getting approved for Florida Medicaid can be challenging, often entangled with red tape, guidelines, regulations, and rules. Whether you're starting to prepare for Medicaid eligibility or if you're dealing with a denial, it's essential to understand why would Medicaid be denied so it doesn’t happen to you. Any mistakes can be expensive and may delay your access to much-needed healthcare and support. 

In this blog, we'll share seven common reasons behind Medicaid denials in Florida and provide guidance on navigating these potential roadblocks. Our goal at Family First Firm is to ensure you and your loved ones can enjoy your golden years without undue financial stress or strain.

If you have questions or need help with a Medicaid application denial, call (407) 574-8125 to schedule a consultation with a member of our Medicaid planning attorney team. At Family First Firm, we’re always by your side to provide simple yet creative legal solutions to protect your family’s legacy.

1. Excessive Income and Assets

A major hurdle you may face when applying for Medicaid relates to your income and assets. Medicaid is designed to assist Americans, particularly those aged 65 and older who live below a certain income threshold. 

If your total income and assets exceed Medicaid’s established limits, your application will be denied. However, don’t stress out!  There are many ways to protect your assets and income and still get eligible for this important benefit.  In order to take advantage of these strategies, you need to work with a Florida elder law attorney. 

Additionally, the “medically needy” program could provide a lifeline even if your income initially seems too high for standard Medicaid qualification. This program caters to seniors requiring long-term care and individuals who are blind or have disabilities, and it could provide the help you need despite your income.

2. Improper Disclosure of Assets

Complete transparency is crucial during the Medicaid application process. If you've overlooked mentioning any asset, such as real estate, stocks, or your bank account balances, this oversight could be a reason for denial. Ensuring you provide a complete and accurate snapshot of your financial situation is paramount. 

Remember, every asset counts in this process, no matter how big or small. If there's a discrepancy, even if unintentional, it could jeopardize your application's approval. So, when preparing your application, listing all your assets without exception is crucial.

3. Failing to Meet Residency and Citizenship Requirements

As you plan to apply for Medicaid, it's important to remember that your residency and citizenship status can be deciding factors in the outcome of your application. As a state-funded program, Medicaid in Florida is available to residents of the Sunshine State who are also U.S. citizens or qualified aliens. 

If your status doesn't align with these criteria, it may lead to a denied application. We recommend consulting with a Florida Medicaid planning attorney to assist you in validating your eligibility and providing the right documentation to support your application.

4. Incomplete Application or Lack of Documentation

The process of applying for Medicaid can be quite complex and challenging, demanding a comprehensive set of documents. Failing to provide adequate information or omitting necessary paperwork like proof of income, or verification of your Social Security number, can often result in a denial of your application. 

It's in these situations where the help of an experienced Medicaid lawyer is critical. Your attorney can help ensure your application is meticulously prepared and all-inclusive, all necessary documents are correctly submitted, and everything is done within the required timeline. Their assistance can make the process smoother and increase your chances of a successful application.

5. Inappropriate Spend Down or Transfer of Assets

Medicaid reviews any asset transfers you've made within five years of your application date, known as the look-back period. If you've transferred assets for less than their fair market value during this period, you might become ineligible for Medicaid – this is a common pitfall for many applicants.

For example, selling a property to a family member at a significantly reduced price could impact your Medicaid eligibility. This is because Medicaid might view this transaction as an attempt to meet its asset limit requirements artificially, which could lead to a period of Medicaid ineligibility.

In some cases, you may purposefully “spend down” your assets to qualify for Medicaid. A “spend down” process involves reducing your countable assets to fall within Medicaid's eligibility limit. This could mean paying off debt, making home improvements, or paying for medical or education expenses.

However, "spending down" should be done carefully and under an experienced Medicaid planning attorney's guidance. This is to avoid any transactions that could be misconstrued as an inappropriate transfer of assets, leading to a penalty period of Medicaid ineligibility.

6. Denial Because You Applied Too Soon

Timing is a crucial factor when applying for Florida Medicaid. You may have heard the phrase, "It's better to apply sooner rather than later," but in the case of Medicaid, applying too soon could lead to a denial.

For instance, if you apply before you have spent down your assets to meet Medicaid's financial eligibility requirements, you will be denied. The same goes for income. If you apply before your income is at or below the state's income limit for Medicaid, you will also be denied.

The key is to ensure that you meet all the eligibility criteria before applying. This is where a Medicaid attorney can be a significant asset. They can guide you through the timing of your application, helping you to spend down your assets legally and appropriately and ensure your income is correctly managed to meet Medicaid's requirements.

7. Ineligibility Due to Health Status

Just as your financial status plays a role in your Medicaid eligibility, so does your health status. Medicaid's long-term care programs are designed to assist those requiring a specific care level. So, if your health conditions do not align with these requirements, you may encounter a Medicaid denial. 

For example, if you require help with daily activities such as bathing, dressing, or eating but are otherwise in good health, you may not qualify for long-term care benefits through Medicaid. Consulting with a Medicaid lawyer can help ensure your needs align with program requirements.

Family First Firm: Safeguarding Your Legacy with Medicaid Planning

A Medicaid application denial can be frustrating, but remember, it's not the end of the road. You have the right to appeal, and the team at Family First Firm is ready to help you through the process. We'll examine the reasons for your denial, create a strategic action plan, and prepare for your appeal.

Our experienced Medicaid attorneys don't just handle appeals. We can also guide you through the application process from the beginning, saving you valuable time and effort. We’ll strategize to ensure your eligibility for benefits, anticipate potential issues, and create an effective plan for appeals, if necessary.

If you've faced a Medicaid denial or are preparing to apply, there’s no need to search online for a “Medicaid attorney near me.” Let the Medicaid planning attorneys at Family First Firm help you navigate your Medicaid journey. Contact us at (407) 574-8125 or online to schedule your consultation. 

For further information about Medicaid, we invite you to read our “Medicaid 101 Guide.”

At Family First Firm, we’re always by your side to provide simple yet creative legal solutions to protect your family’s legacy.

Copyright © 2024. Family First Firm - Medicaid & Elder Law Attorneys. All rights reserved.
The information in this blog post (“post”) is provided for general informational purposes only and may not reflect the current law in your jurisdiction. No information in this post should be construed as legal advice from the individual author or the law firm, nor is it intended to be a substitute for legal counsel on any subject matter. No reader of this post should act or refrain from acting based on any information included in or accessible through this post without seeking the appropriate legal or other professional advice on the particular facts and circumstances at issue from a lawyer licensed in the recipient’s state, country, or other appropriate licensing jurisdiction.
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