Top Reasons For Medicaid Denial Or Delay

Some of the Most Common Reasons for Medicaid Denial Include: 

  1. Incomplete Applications or Documentation
  2. Failure to Quickly Answer Follow-Up Questions
  3. Income is Too High
  4. Not Financially Eligible for Medicaid When You File
  5. Filing Too Late
  6. You Have Too Much Money
  7. Income Trust is Not Properly Funded
  8. Incomplete Physician’s Statement 

Below you will find more details about the different reasons for Medicaid denial. 

Medicaid Denial Reasons: 

1. INCOMPLETE APPLICATIONS OR DOCUMENTS

Now it is more important than ever to have a complete packet when filing your Medicaid application. Once the packet is filed, if it is incomplete Medicaid will ask for additional information. It used to be that they would wait as long as they knew you were trying to get the additional information; now they are quick to deny if follow-up information is not filed quickly.

2. FAILURE TO PROVIDE SUPPORTING DOCUMENTATION IN A TIMELY MANNER

Once the application is filed, if Medicaid has questions, they will send a letter requiring a response within 10 days. That’s 10 days from when they send, not when you receive the letter. Some will allow an extension but gone are the days when applicants could extend several times. We find it best to collect as much as possible, BEFORE filing the application.

3. INCOME TOO HIGH

Since Florida is an “Income Cap State” there is no flexibility when it comes to being over income. All income, no matter where it is from, counts.

4. FILING TOO EARLY

If you are not financially eligible for Medicaid when you file, your application will be denied. Also, if you do not need the care yet, you will be denied.

5. FILING TOO LATE

Medicaid will go back up to 90 days only as long as the applicant was eligible during that period, but not any longer.

6. TOO MUCH MONEY

Medicaid has strict limits on how much an individual, and if applicable, their spouse can have. Being even slightly over can cause one to be denied. However, with proper and careful planning, certain assets can be protected.

7.  INCOME TRUST NOT PROPERLY FUNDED

An income trust is the only solution for being “over income”. Having the trust is only step one. An account for the income trust must be established and every penny that is over the income cap limit must go through this trust. If not, the applicant is denied for that month.

8.  PHYSICIAN’S STATEMENT

If not completed properly, and signed & dated by the physician, the Medicaid application can be denied. Filers should stop and fully review before sending in forms completed by others.

Schedule a free consultation with our St. Petersburg Medicaid lawyers today by calling (727) 240-2350.

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