If you apply for long-term care assistance through Medicaid [ALTCS in Arizona] and your application is denied, it may feel hopeless. The good news is that you can appeal the decision.
Medicaid is a program for low-income individuals, so it has strict income and asset eligibility requirements. Qualifying for ALTCS requires navigating the complicated application process, which has many potential stumbling blocks. However, an ALTCS denial does not mean you will not eventually qualify for benefits.
ALTCS may deny an application for a number of reasons, including the following:
- Missing documentation. You need to show proof that you are eligible for benefits, which usually means providing Social Security statements, bank records, property deeds, retirement accounts, and insurance records, among other things.
- Excess assets. In order to be eligible for Medicaid benefits a nursing home resident may have no more than $2,000 in “countable” assets (in most states).
- Transferred assets. If you transferred assets for less than market value within five years before applying for benefits, you may be subject to a penalty period before you become eligible for benefits.
- Medical eligibility. Qualified Medicaid applicants must require a significant amount of assistance in their daily activities.
ALTCS is required to issue the denial notice with 45 days of the application. When you get a denial notice, read it carefully. The notice will explain why the application was denied and specify how to file an appeal.
Before filing a formal appeal, you can try informally asking the agency to reverse the decision. If you made a mistake on the application, this is the easiest and quickest way to proceed. If the caseworker made a mistake, it may be more complicated and require escalation to a supervisor or a formal appeal. And in some situations, it is easier and better to reapply than to appeal a decision.
Appealing a Decision
The denial notice will tell how long you have to file an appeal—for ALTCS benefits, the deadlines is 35 days after the denial notice. It is important to file the appeal before the deadline. Whether the denial notice requires it or not, you should submit your request for an appeal in writing, so that there is a record of it.
Once your appeal is submitted, ALTCS will set a hearing date. Applicants must attend the hearing or their cases will be dismissed. You have a right to have witnesses testify at the hearing and to question the Medicaid agency’s witnesses. It is a good idea to have an attorney to help you through the appeal process. An attorney can make sure you have all the correct documentation and information to present at the hearing.
If you win the appeal, your benefits will be retroactive to the date of your eligibility—usually the date of your application. If you lose the appeal, the notice will explain how to appeal the decision. The next step in the appeal process usually involves submitting written arguments. If the next appeal is unsuccessful, then you will have to appeal to court. It is crucial to have the assistance of an attorney for this.
Reapplying for Benefits
If your application was denied correctly due to excess assets or income, there are steps you can take to spend down your assets or put your income in a trust. Or perhaps your medical condition has worsened or could be described more accurately since your original application. Contact our firm to find out what actions you can take to qualify for benefits. Once you do this, you can then reapply for benefits. Note that when you reapply for benefits, your eligibility date will change to the date of the new application.