Nursing Home Medicaid Denied – Now What Do You Do?

If you already gambled $7,500-$13,000 (or more) in nursing home bills on attempting to establish nursing home Medicaid eligibility for your loved one and lost, what do you do? My suggestion, stop making mistakes and fix it as soon as possible.

The HHSC Denied You Because…

The HHSC denies applications for Medicaid nursing home benefits every day. They deny cases for a a variety of reasons. You might not have filled out a certain part of the application correctly. The case worker may not be applying the correct law to a specific issue. You might not have provided sufficient evidence on a certain issue.

Whatever the reason for the denial is, there are a couple steps you should take as soon as possible to minimize the nursing home bill you are running up. Do not wait until 2 or 3 months later because if the mistake is on your end you have just racked up another 2 to 3 months of nursing home bills that Medicaid is not going to cover.

Step 1

First, follow the instructions included with the denial notice to appeal the HHSC denial of Medicaid nursing home benefits. The reasons for filing a prompt appeal are: 1) it will get you an earlier hearing date than if you wait and 2) it will get you a copy of the HHSC’s file. If for some reason the appeal is not worth pursuing you can always withdraw it later on but until you have completely evaluated the basis of the denial I suggest starting the appeal process as soon as possible.

Don’t Fall for this Trap

If you call the HHSC to appeal, some of the case workers  will try to talk you out of it and tell you it is quicker to re-apply than appeal but do not fall for it. If the mistake is on their end and you do not appeal the denial then you can be stuck with nursing home bills for the months they denied benefits for even if their denial was wrong.

Step 2

Second, have your case reviewed by an experienced nursing home Medicaid attorney as soon as possible. The reason for this is certain eligibility criteria have to exist as of the 1st of the month in order to establish Medicaid eligibility. You could sacrifice an entire month of Medicaid eligibility if you need to fix something with your case but don’t find out about it until after the 1st of the month.

Sometimes the reason for a Medicaid denial is a mistake on the part of the HHSC. Sometimes the reason for a denial is a mistake on your part. In either case, someone who knows what they are doing can usually fix the roblems. If your loved one has been denied nursing home Medicaid and you need experienced representation for your case, call me at (832) 592-7913.